title: [Medium-term results of grade 3 and 4 cystocele repair by porcine xenograft matrix (pelvicol)].
abstract: OBJECTIVE
  To evaluate the medium-term results of grade 3 and 4 (Baden-Walker classification) cystocele repair by transvaginal porcine xenograft matrix (Pelvicol).
  
  
  METHODS
  Between February 2002 and October 2005, fifty patients with grade 3 or 4 cystocele were treated by Pelvicol matrix. The preoperative grade of prolapse and symptoms (urinary and pelvic heaviness) were recorded and a sexuality questionnaire was completed retrospectively (BISF-W questionnaire). All patients were reviewed in the outpatients department at 1 month and at the date of last follow-up. The success of the surgical procedure was defined by postoperative grades 0 and 1. Preoperative and postoperative symptoms and sexuality were compared. The operative morbidity was recorded. The success of the surgical procedure was compared in patients operated for the first time and in redo patients.
  
  
  RESULTS
  The mean age was 69.4 years; 29 patients had a grade 3 cystocele (58%), and 21 had a grade 4 cystocele (42%). Preoperative symptoms consisted of dysuria (32%) and symptoms of overactive bladder (22%), accompanied by symptomatic (36%) or asymptomatic (20%) stress urinary incontinence. Pelvic heaviness was present in 100% of cases. An associated procedure was necessary in 70% of cases (29 suburethral tapes, 6 rectocele repairs, 3 vaginal hysterectomies). Mean follow-up was 27.2 months (95%CI [23.3-31.1]). No intraoperative or postoperative complications were observed. During follow-up, no cases of rejection of material, vaginal erosion or delayed healing were observed. The surgical success rate was 94% (37 grade 0 and 10 grade 1). Dysuria and pelvic heaviness were significantly improved. None of the 10 women who were sexually active preoperatively reported postoperative discomfort. Among the 50 operated patients, 35 (70%) were treated by Pelvicol as first-line procedure and 15 were redo procedures (30%); no significant difference in surgical success rate was observed between these two groups (94.3% versus 93.4%).
  
  
  CONCLUSIONS
  The use of a porcine xenograft matrix (Pelvicol) appears to be a safe and effective technique in the medium term for first-line treatment of grade 3 and 4 cystocele.
authors.affiliation: Service d'Urologie, Hôpital Tenon, Paris, France. yannickrouach@hotmail.com
authors.forename: Yannick
authors.initials: Y
authors.lastname: Rouach
authors.forename: Philippe
authors.initials: P
authors.lastname: Sebe
authors.forename: Jerome David
authors.initials: JD
authors.lastname: Barouk
authors.forename: Philippe
authors.initials: P
authors.lastname: Thibault
authors.forename: Francois
authors.initials: F
authors.lastname: Haab
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001705:Bioprosthesis; D052858:Cystocele / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors