[The prosthetic kits in the prolapse surgery: is it a gadget?].
OBJECTIVE
To search if the prosthetic kits bring an interest, other that financier.


METHODS
Authors have counted 5 firms presenting the varied kits. The Prolift kit with synthetic pre- cut mesh made of polypropylene, standardized needle, cannulas and protective devices of recovery of mesh arms in 3 versions, anterior, posterior and total. Perigee and Apogee systems in a synthetic version (IntePro) and a biological version (InteXen ++LP) matched of specific needles for the different obturator passages and infra coccygeus. The Avaulta kit declines in a biosynthetic version and a hybrid version with a specific needle for its anterior kit and an other for its posterior kit. The Biomesh Soft system presents a polypropylène mesh posed on a multi pattern sheet to carve following dots with a share of 3 needles according to the type of arm passage ended by a recuperator thread. The Nazca POP Repair System, in its anterior version claims to be able to correct in the same time a urinary incontinence by pre-pubic arms. The polypropylene mesh is perforated and is had with the help a needle for its anterior and posterior kit. Authors have been interested in the research of studies on prosthesis with and without kit.


RESULTS
The Prolift kit contains the alone prosthesis having been evaluated without (TVM) and with kit. Authors remind results of two studies, understanding 684 cases without kit and 110 cases with kit. The rate of early per and postoperative complications has been decreased half, the rate of mesh exposure decreased from 11,3 to 4,7%. Studies on Perigee and Apogee IntePro kits, whose meshe and the procedure are similar to the Prolift seem to obtain from results equal. The Biological version has not made the object of study. For the Avauta kit, alone the mesh in plate not pre-cut has been well studied as for its tolerance for the biosynthetic version. Nothing on the hybrid version. No study is found for the Biomesh Soft kit and Nazca POP repair system.


CONCLUSIONS
The cost of these kits, varying 1 to 4, is to take in consideration and to put in scale with the returned service. Alone TVM/Prolift allows to advance in a reply. The utilization of needles, presents in all the kits, but especially devices facilitating the passage and the recovery of prosthesis arms, presents solely in the Prolift kit, reduce the utilization of valves and the risk of tear tissues during their job. The improvement of techniques by elements of the kit make that the surgical procedure become mini invasive.


CONCLUSIONS
The full kits allow a best security of procedures, facilitate the surgical gesture and limit complications. It is necessary to remain vigilant in the evaluation of these new materials "ready to wear" and to require pre clinic and clinic studies before their distribution.
Debodinance
P
P
Service de Gynécologie-Obstétrique, Centre Hospitalier Dunkerque, Rue des Pinsons, Saint-Pol-Sur-Mer, France. ph.debodinance@wanadoo.fr
Amblard
J
J
Fatton
B
B
Cosson
M
M
Jacquetin
B
B
D003362:Cost-Benefit Analysis; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D017773:Pelvic Floor / Q000601:surgery; D011474:Prosthesis Design; D013526:Surgical Mesh; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000295:instrumentation / Q000379:methods; D014596:Uterine Prolapse / Q000601:surgery*