title: Cystocele recurrence after anterior colporrhaphy with and without mesh use.
abstract: OBJECTIVE
  Mesh reinforcement in cystocele repair has become popular in recent years, with some evidence of reduced recurrence rates. In this retrospective cohort series, we aimed to assess subjective and objective outcomes, including ultrasound quantification of prolapse, following anterior colporrhaphy with and without mesh use for anterior compartment prolapse.
  
  
  METHODS
  We assessed anatomical and functional outcomes of patients after cystocele repair in three tertiary urogynecology units. Outcome measures included either objective prolapse recurrence (defined as cystocele≥Stage 2 ICS POP-Q or bladder descent ≥10mm below the symphysis pubis on ultrasound) or subjective prolapse recurrence (defined as symptoms of vaginal lump, bulge or dragging sensation post-operatively). Comparisons between mesh use and anterior colporrhaphy-only groups were undertaken, adjusting for potential confounders (age, BMI, vaginal parity, previous prolapse repair, levator avulsion and length of follow-up) using multiple linear regression and logistic regression methods.
  
  
  RESULTS
  183 patients were assessed at an average follow-up of 4 years. Eight-three patients had anterior colporrhaphy between January 2002 and December 2005, and 100 had an anterior mesh repair between March 2004 and October 2008. Forty-six (55%) patients in the anterior colporrhaphy group compared to 33 (33%) in the mesh use group were diagnosed with a recurrent cystocele (≥stage 2) (p=0.002). After adjustment for age, BMI, previous vaginal delivery, previous vaginal repair surgery, and length of follow-up, the benefit of mesh on prolapse recurrence was principally experienced by women with major levator trauma.
  
  
  CONCLUSIONS
  At a mean of four years' follow-up, mesh augmentation was associated with reduced cystocele recurrence, but this effect was limited to patients with levator avulsion.
authors: Sydney Medical School Nepean, University of Sydney, Penrith, NSW, Australia. Electronic address: vivwlp@yahoo.co.nz.
authors: Vivien
authors: V
authors: Wong
authors: Sydney Medical School Nepean, University of Sydney, Penrith, NSW, Australia.
authors: Ka Lai
authors: KL
authors: Shek
authors: Greenslopes Private Hospital, Queensland, Australia.
authors: Judith
authors: J
authors: Goh
authors: Greenslopes Private Hospital, Queensland, Australia.
authors: Hannah
authors: H
authors: Krause
authors: NHMRC Clinical Trials Centre, University of Sydney, Australia.
authors: Andrew
authors: A
authors: Martin
authors: Sydney Medical School Nepean, University of Sydney, Penrith, NSW, Australia.
authors: Hans Peter
authors: HP
authors: Dietz
mesh_terms: D000368:Aged; D015331:Cohort Studies; D052858:Cystocele / Q000601:surgery*; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008875:Middle Aged; D017773:Pelvic Floor / Q000293:injuries*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013526:Surgical Mesh; D016896:Treatment Outcome
keywords: Anterior colporrhaphy; Cystocele; Levator avulsion; Mesh; Recurrence