title: Biologic grafts for cystocele repair: does concomitant midline fascial plication improve surgical outcomes?
abstract: OBJECTIVE
  This study aims to compare the efficacy of porcine graft-augmented anterior prolapse repair with and without underlying pubocervical fascia plication.
  
  
  METHODS
  Women with symptomatic anterior prolapse who underwent transvaginal repair, using biologic graft via transobturator approach, were retrospectively studied. An initial cohort had the graft placed without fascial plication. A second cohort had graft placement as an overlay to fascial plication.
  
  
  RESULTS
  Between March 2005 and September 2008, 65 subjects underwent anterior repair with biologic graft; 35 without fascial plication and 30 as an overlay to plication. At 6 months follow-up, anatomic recurrence (Ba>/= -1) was significantly higher in the non-plicated group (18/35, 51%) compared with the plicated group (2/30, 7%) p < 0.01. Five (5/35, 14%) in the non-plicated group compared with none (0/30) in the plicated group underwent further treatment (p = 0.06).
  
  
  CONCLUSIONS
  When using a non-crosslinked biologic graft for repair of anterior vaginal prolapse, we recommend the addition of concomitant midline fascial plication to enhance anatomic outcome.
authors.affiliation: Department of Gynecology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL 33331, USA.
authors.forename: Deborah R
authors.initials: DR
authors.lastname: Karp
authors.forename: Thais V
authors.initials: TV
authors.lastname: Peterson
authors.forename: Ayman
authors.initials: A
authors.lastname: Mahdy
authors.forename: Gamal
authors.initials: G
authors.lastname: Ghoniem
authors.forename: Vivian C
authors.initials: VC
authors.lastname: Aguilar
authors.forename: G Willy
authors.initials: GW
authors.lastname: Davila
mesh_terms: D000368:Aged; D001705:Bioprosthesis; D052858:Cystocele / Q000601:surgery*; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D012008:Recurrence; D012189:Retrospective Studies; D012725:Sexual Behavior; D016896:Treatment Outcome