title: Site-specific prolapse surgery. II. Vaginal paravaginal repair augmented with either synthetic mesh or remodelling xenograft.
abstract: OBJECTIVE
  This study aims to answer the question, "Does tissue augmentation improve the mechanical repair of displacement cystourethrocoele?"
  
  
  METHODS
  A retrospective cohort study comparing 108 bridging graft vaginal paravaginal repairs (89 tissue-inductive xenografts and 19 polypropylene mesh) to 59 native tissue historical controls was conducted. Main outcome measures were same-site prolapse recurrence and time to failure. Initial reliability was evaluated by chi-squared test, 10-year durability by Kaplan-Meier survival analysis and risk factors by Cox regression.
  
  
  RESULTS
  Late recurrence was 17.7% lower with augmentation (logrank test χ (2) = 8.4, p value = 0.0038 < 0.05, adjusted regression analysis χ (2) = 2.94; p value = 0.0866 <0.10), implicating collagen degeneration in repair failure.
  
  
  CONCLUSIONS
  Rebuilding the pubocervical septum, from arcus to arcus and pubic ramus to pericervical ring, satisfies the mechanical but not the metabolic hernia principles. Bridging grafts simplify technical repair (reducing prolapse persistence from 10.2% to 4.6%), and also rejuvenate adjacent connective tissue (reducing late recurrence from 22.6% to 4.9%).
authors.affiliation: School of Rural Medicine, Armidale, Australia. richard_reid@dbgyn.com
authors.forename: Richard I
authors.initials: RI
authors.lastname: Reid
authors.forename: Kehui
authors.initials: K
authors.lastname: Luo
mesh_terms: D001705:Bioprosthesis; D016009:Chi-Square Distribution; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000601:surgery*; D014621:Vagina / Q000601:surgery*