Uterus-sparing vaginal surgery of genitourinary prolapse employing biocompatible material.
OBJECTIVE
The study presents an original uterus sparing technique for transvaginal repair of total genitourinary prolapse. The technique employs a synthetic mesh of mixed polypropylene and 910 polyglactin fibers.


METHODS
The prosthesis creates a support for the cystocele, the cervix and the enterocele. It has four anchoring sites: two at the rear in the sacrospinous ligaments and two at the front in the arcus tendineous of the levator ani muscle. Between February 2001 and December 2004, 24 patients (mean age 66.9 years), presenting symptoms of uterine prolapse, cystocele and enterocele (POP-Q stage III-IV Aa associated to II-III-IV C), were treated with our procedure. Pre- and postoperative parameters were evaluated statistically.


RESULTS
No patient had any serious complications. The mean follow-up was 31.1 months (range 6-52). 19 patients (79.1%) have shown excellent results and have been completely cured. In 5 other cases (20.8%), the cystocele was completely cured and there was a significant improvement in the hysterocele and the enterocele. One patient required surgical treatment for postoperative stress incontinence. Statistical analysis of data regarding the pre- and postoperative prolapse stage demonstrated a high degree of objective cure rates (p < 0.0001).


CONCLUSIONS
While hysterectomy remains the habitual treatment for severe uterine prolapse, our technique provides a promising alternative solution. It is also significant that there were no complications of erosion or infection associated with the prosthesis.
Nicita
Giulio
G
Clinica Urologica II, I.T.T., University of Florence, Florence, Italy. gnicita@unifi.it
Li Marzi
Vincenzo
V
Filocamo
Maria Teresa
MT
Dattolo
Eugenio
E
Marzocco
Michele
M
Paoletti
Maria Cristina
MC
Villari
Donata
D
D000368:Aged; D001672:Biocompatible Materials; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011098:Polyglactin 910; D011126:Polypropylenes; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000295:instrumentation*; D012189:Retrospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000601:surgery*; D014621:Vagina / Q000601:surgery*
D001672:Biocompatible Materials; D011126:Polypropylenes; D011098:Polyglactin 910