title: A prospective, randomized, controlled trial of the treatment of anterior vaginal wall prolapse: medium term followup.
abstract: OBJECTIVE
  We compared the efficacy and safety of anterior colporrhaphy with transvaginal polypropylene mesh insertion for anterior vaginal wall prolapse at medium term followup.
  
  
  METHODS
  In this prospective, randomized, controlled trial 100 women with stage II or greater anterior vaginal wall prolapse assessed by POP-Q were randomized to anterior colporrhaphy (controls) or mesh insertion. Anatomical outcomes were assessed by POP-Q measurement and prolapse stage. Subjective outcomes and quality of life impact were evaluated by ICIQ questionnaires. We evaluated the procedure safety profile according to intraoperative complication rates throughout followup.
  
  
  RESULTS
  In the mesh and control groups 42 and 50 women completed the 24-month followup. Point Ba did not significantly differ between the groups at baseline but at 24-month followup it had significantly improved in the mesh group compared to controls. However, no difference was found between the groups when considering 2 cure criteria on prolapse stage and subjective parameters. Asymptomatic mesh exposure developed on the anterior vaginal wall prolapse in 7 patients (16.4%) in the mesh group. Minor mesh related complications consisted of mesh exposure, prepubic ecchymosis and groin pain, of which most were treated conservatively. Urinary retention was treated surgically.
  
  
  CONCLUSIONS
  Nazca TC™ and anterior colporrhaphy provided good overall anatomical outcomes during a minimum 24-month followup. Vaginal and urinary symptoms, and quality of life improved postoperatively in each group. From the patient perspective Nazca TC did not show superior overall outcomes compared to anterior colporrhaphy performed with or without a retropubic sling.
authors.affiliation: Department of Urology, Faculty of Medicine of São Carlos, Federal University of São Paulo, São Paulo, Brazil. Electronic address: tadeutamanini@ufscar.br.
authors.forename: José Tadeu Nunes
authors.initials: JT
authors.lastname: Tamanini
authors.affiliation: Ambulatory of Urogynecology, Secretary of Health and Santa Casa Hospital, Jaú, Brazil.
authors.forename: Renata Cristina
authors.initials: RC
authors.lastname: de Oliveira Souza Castro
authors.affiliation: ABC School of Medicine, Santo André, Brazil.
authors.forename: Juliana Milhomem
authors.initials: JM
authors.lastname: Tamanini
authors.affiliation: Section of Urogynecology and Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Rodrigo Aquino
authors.initials: RA
authors.lastname: Castro
authors.affiliation: Section of Urogynecology and Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Marair Gracio Ferreira
authors.initials: MG
authors.lastname: Sartori
authors.affiliation: Section of Urogynecology and Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Manoel João Batista Castello
authors.initials: MJ
authors.lastname: Girão
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D013997:Time Factors; D014596:Uterine Prolapse / Q000601:surgery*; D014621:Vagina / Q000601:surgery*
keywords: cystocele; female; pelvic organ prolapse; surgical mesh; urinary bladder