Tension-free cystocele repair: an analysis after a follow-up of 24 months.
OBJECTIVE
The aim of the study is to verify whether tension free cystocele repair is really a good choice for the correction of moderate or severe cystocele. The surgical approach is transvaginal and involves the use of nonabsorbable prolene mesh.


METHODS
We enrolled 177 women with a combined genital prolapse, characterized by second degree cystocele, first degree hysterocele and first degree rectocele or more severe conditions. All the patients underwent a complete urologic and gynecologic work-up before the surgical treatment consisting in a Y-shaped mesh placed on the prevesical fascia. This technique was implemented providing a tension free prosthesis.


RESULTS
Our results on a total of 169 patients after a follow-up of 24 months are the following: 19 patients (11%) reported a recurrent cystocele (grade II) of which 9 patients at 6 months follow-up presented a vaginal wall erosion that determined a surgical explantation of the mesh; 2 patients (1%) showed a persistent dyspareunia and were treated with estrogen therapy that gave an improvement of the symptomatology although it did not disappear; 10 (6%) patients, among the women treated only for cystocele repair (cystocele III ), complained of stress urinary incontinence of 1st degree; and, finally, 150 patients (89%) didn't report any recurrence of cystocele.


CONCLUSIONS
Given the good results obtained after a follow-up of 24 months (89% of the cure rate), we can consider this procedure simple, mini-invasive, reproducible and efficient with low morbidity and good tolerance. It is a promising approach in the management of pelvic floor dysfunctions that induces minimal foreign body reaction.
Granese
R
R
Department of Obstetrics and Gynaecology, University of Messina, Messina, Italy. robertagr74@aliceposta.it
Adile
B
B
D000328:Adult; D000368:Aged; D052858:Cystocele / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D008875:Middle Aged; D011126:Polypropylenes; D020047:Rectocele / Q000601:surgery; D012008:Recurrence; D013526:Surgical Mesh; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000209:etiology; D013520:Urologic Surgical Procedures / Q000379:methods*; D014596:Uterine Prolapse / Q000601:surgery
D011126:Polypropylenes