Combined Burch urethropexy and anterior rectopexy in pelvic organ prolapse: skip the mesh.
OBJECTIVE
Pelvic organ prolapse (POP) is a common accompaniment of advancing age. Current repair techniques incorporate transvaginal and transabdominal approaches with or without prosthetic mesh insertion. In this paper, we present the short- and medium-term results of a unit policy directed at patients with POP of combined abdominal rectopexy and Burch retropubic urethropexy without the use of prosthetic mesh assessing its safety profile in selected cases.


METHODS
Between January 2009 and January 2011, 16 women with tri-compartmental prolapse who had all undergone prior hysterectomy underwent combined surgical pelvic floor repair. Preoperative symptom assessment by validated questionnaires and clinical examination were pre- and postoperatively recorded. Cures were defined as either optimal or satisfactory outcomes based on combined clinical, radiological examinations and reported patient satisfaction.


RESULTS
The mean age of the 16 patients was 57.2 years, and their mean BMI was 28.6 (±5 SD). Pelvic examination revealed a POP-Q stage III prolapse in 12 patients and stage IV in 4 patients. The mean operating time was 57.5 min (range 40-85), with a mean length of hospital stay of 4.5 days. Cystocele and enterocele resolution was noted in every case on dynamic magnetic resonance imaging (MRI).


CONCLUSIONS
Our results in a small patient cohort employing a simple 'all-in-one' repair approach combining a retropubic colposuspension with an anterior rectopexy appear to be satisfactory. Further larger randomized studies are required, incorporating a laparoscopic arm in order to determine the longer-term effectiveness of this approach.
Department of Surgical Sciences, "Sapienza" University of Rome, V.le Regina Elena n° 324, 00161 Rome, Italy.
Daniele
D
Pironi
Stefano
S
Pontone
Vlasta
V
Podzemny
Alessandra
A
Panarese
Maurizio
M
Vendettuoli
Domenico
D
Mascagni
Angelo
A
Filippini
D005260:Female; D006801:Humans; D007044:Hysterectomy; D007902:Length of Stay / Q000706:statistics & numerical data; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D017060:Patient Satisfaction; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D016896:Treatment Outcome