Tension-free polypropylene mesh for vaginal repair of anterior vaginal wall prolapse.
OBJECTIVE
To study the ongoing results of the repair of anterior vaginal wall prolapse reinforced with tension-free polypropylene mesh (GyneMesh, Gynecare, Ethicon, Issy-Les-Moulineaux, France).


METHODS
A case series of 87 consecutive women with anterior vaginal wall prolapse who underwent a transvaginal procedure using polypropylene mesh between October 1999 and August 2002. The mean age (+/-SD) was 62.4+/-13.4 years. Before the operation, patients underwent physical examination staging of the prolapse with the International Pelvic Organ Prolapse staging system. Thirteen women had stage 2 anterior vaginal wall prolapse (14.9%), 59 had stage 3 (67.9%), and 15 had stage 4 (17.3%). The polypropylene mesh was placed from the retropubic space to the inferior part of the bladder in a tension-freefashion. Patients were followed for 9-43 months, with a median follow-up (+/-SD) of 24+/-9.6 months. We defined "cure" as satisfactory (stage 1) or optimal (stage 0) outcome for point Ba in the staging system.


RESULTS
Eighty-four patients returned for follow-up (96.6%). At follow-up, 77 women were cured (91.6%), 5 women had asymptomatic stage 2 anterior vaginal wall prolapse, and 2 had a recurrent stage 3 (2.4%). There were no postoperative infections. There were a total of 7 vaginal erosions of the mesh (8.3%); 4 necessitated a second procedure for partial excision of the mesh.


CONCLUSIONS
Vaginal repair of anterior vaginal wall prolapse reinforced with tension-free polypropylene mesh is effective and relatively safe. Vaginal erosion occurred in 8.3% of the study population but was easily manageable, with no sequelae.
de Tayrac
Renaud
R
Department of Obstetrics and Gynecology, Antoine Béclère Hospital, Clamart, France. renaud.detayrac@abc.ap-hop-paris.fr
Gervaise
Amélie
A
Chauveaud
Aurélia
A
Fernandez
Hervé
H
D017677:Age Distribution; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D017060:Patient Satisfaction; D011126:Polypropylenes; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013526:Surgical Mesh; D013718:Tensile Strength; D016896:Treatment Outcome; D014479:United Arab Emirates / Q000453:epidemiology; D014596:Uterine Prolapse / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*
D011126:Polypropylenes