Transobturator mesh for cystocele repair: a short- to medium-term follow-up using 3D/4D ultrasound.
OBJECTIVE
Anterior colporrhaphy has been shown to have limited medium-term success rates in cystocele repair. Many clinicians use mesh implants, but their safety and efficacy are controversial. We therefore performed an external surgical audit using three- and four-dimensional pelvic floor ultrasound to study the short- to medium-term results of transobturator mesh placement.


METHODS
Forty-six women who had undergone transobturator mesh anterior repair using the Perigee(TM) system were invited back for a follow-up appointment conducted by two non-surgeons. The appointment consisted of a standardized interview, clinical examination using the International Continence Society Pelvic Organ Prolapse Quantification system (ICS POP-Q) and translabial ultrasound examination.


RESULTS
The mean follow-up time was 10 (range, 2-24) months. There had been no major intra- or postoperative complications. Thirty-six (78%) patients were subjectively satisfied with the outcome of the procedure. Cystocele recurrence (Stage 2 or 3) was observed in six (13%) patients. There were three (6.5%) cases of mesh erosion. On translabial ultrasound, we observed cystocele recurrence dorsal to the mesh in five women, associated with a marked change in mesh axis on Valsalva, implying dislodgment of the superior anchoring arms. The mesh was measured at a mean of 21 (range, 8.8-37.3; SD, 7.0) mm in length.


CONCLUSIONS
At 10-month follow-up the Perigee procedure seems to be safe and effective for cystocele repair, with a satisfaction rate of 78%. In some women recurrence may occur due to dislodgment of the superior anchoring arms.
Nepean Clinical School, University of Sydney, Penrith, Australia. shekkalai@yahoo.com.hk
K L
KL
Shek
H P
HP
Dietz
A
A
Rane
S
S
Balakrishnan
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D052858:Cystocele / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008485:Medical Audit; D008875:Middle Aged; D017060:Patient Satisfaction; D017773:Pelvic Floor / Q000000981:diagnostic imaging* / Q000601:surgery; D019919:Prosthesis Implantation; D013526:Surgical Mesh; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods*; D013520:Urologic Surgical Procedures