title: [New technique for the repair of anterior pelvic floor compartment defects using a synthetic implant with biological coverage: approach, fixation and transobturator anchoring].
abstract: Transobturator systems for anterior vaginal wall prolapse repair exemplify the current trend in pelvic floor surgery. They may be considered an approach and also a mesh fixation system, in opposition to free mesh cystocele repair where they work by the creation of fibrotic tissue after mesh implant (biological or synthetic).
  
  
  OBJECTIVE
  To describe the elements of the Avaulta anterior system, its indications and the surgical technique to implant it and adequately adjust it.
  
  
  METHODS
  The operation has five steps: (1) midline vaginal incision and mucosal dissection, (2) Obturator foramen identification, design and performance of 2 superior mini incisions in both the genitofemoral folds, and another two 3 cm below and 1-2 cm lateral to them, (3) Needle introduction and passage through the upper portion of the obturator foramen, parallel to the ischiopubic ramus, and once past needle charging with the arm of the implant, (4) Needle introduction and passage from the inferior incisions vertically through the inferior portion of the obturator foramen, directing the needle with bimanual control to the theoretical localization of the uterine.cervix, with connection and charging of the inferior arm of the mesh. (5) Tension free adjustment of the mesh and closure of the incisions.
  
  
  CONCLUSIONS
  (1) It is a reproducible technique that adequately corrects the anterior vaginal compartment defects. (2) The design and technology of Avaulta aims to correct the anterior compartment defects, based on the principles of ideal mesh.
authors.affiliation: Cátedra y Servicio de Urología Hospital Clínico San Carlos, Universidad Complutense, Madrid, España. dr_jmoreno@hotmail.com
authors.forename: Jesús
authors.initials: J
authors.lastname: Moreno Sierra
authors.forename: Sara B
authors.initials: SB
authors.lastname: Prieto Nogal
authors.forename: M Isabel
authors.initials: MI
authors.lastname: Galante Romo
authors.forename: Luis E
authors.initials: LE
authors.lastname: Resel Folkersman
authors.forename: Angel
authors.initials: A
authors.lastname: Silmi Moyano
mesh_terms: D001705:Bioprosthesis; D052858:Cystocele / Q000601:surgery*; D005260:Female; D006801:Humans; D017773:Pelvic Floor / Q000601:surgery*; D011474:Prosthesis Design; D013526:Surgical Mesh; D013520:Urologic Surgical Procedures / Q000379:methods; D014596:Uterine Prolapse / Q000601:surgery*; D014621:Vagina / Q000601:surgery*