title: Factors that affect recurrence after anterior colporrhaphy procedure reinforced with four-corner anchored polypropylene mesh.
abstract: The purpose of this study was to evaluate the effectiveness of the anterior colporrhaphy procedure reinforced with four-corner anchored polypropylene mesh in patients with severe (stage III or IV) anterior vaginal prolapse. Thirty-eight consecutive women were enlisted for this prospective study. The procedure consisted of an extensive vaginal dissection to join the vesicovaginal and retropubic space and an anchoring of a polypropylene mesh patch between the two Arcus Tendineus Fasciae Pelvis in a tension-free manner. The mean age of the study group was 63 (33-80) years. The success rate was 87% (33/38) at a mean follow-up interval of 21 (12-29) months. A total of eight (100%) patients were also cured of concomitant stress incontinence (five overt and three occult type) with an additional tension-free vaginal tape (TVT) operation. During follow-up, there were five de-novo stress incontinence cases (16.7%) and four vaginal erosions of mesh (10.5%). Four clinical variables--diabetes mellitus, recurrent anterior vaginal prolapse, chronic cough and vaginal erosions of mesh--were found to have a significant correlation with an unsatisfactory surgical result with large values of hazard ratios found by survival analysis. We concluded that the anterior colporrhaphy procedure reinforced with four-corner anchored polypropylene mesh was effective for most, but failed in some patients who had specific risk factors within short convalescence periods. Concomitant stress incontinence can be successfully treated by a TVT operation in combination with the anterior colporrhaphy procedure reinforced with four-corner anchored polypropylene mesh. However, the anterior colporrhaphy procedure may itself have adverse effects on urethral sphincter function.
authors.affiliation: Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan. mjhung@vghtc.gov.tw
authors.forename: M J
authors.initials: MJ
authors.lastname: Hung
authors.forename: F S
authors.initials: FS
authors.lastname: Liu
authors.forename: P S
authors.initials: PS
authors.lastname: Shen
authors.forename: G D
authors.initials: GD
authors.lastname: Chen
authors.forename: L Y
authors.initials: LY
authors.lastname: Lin
authors.forename: E S C
authors.initials: ES
authors.lastname: Ho
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020884:Colpotomy / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D017773:Pelvic Floor / Q000601:surgery; D011126:Polypropylenes; D011446:Prospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D013526:Surgical Mesh; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000517:prevention & control* / Q000601:surgery
chemical_list: D011126:Polypropylenes