Transvaginal repair of stage III-IV cystocele using a lightweight mesh: safety and 36-month outcome.
OBJECTIVE
The aim of this study was to assess the 36-month safety and efficacy of a lightweight polypropylene mesh used for the transvaginal repair of stage III-IV cystocele.


METHODS
A multicenter prospective cohort study was performed. Preoperative assessment included an interview and evaluation with the Pelvic Organ Prolapse Quantification (POP-Q) system. Inclusion criteria were stage III-IV cystocele and no contraindications for mesh use. A lightweight (28 g/m(2)) four-arm transobturator polypropylene mesh was used for the study. Pre- and postoperative symptoms and quality of life were assessed using the Urinary Symptoms Measurement (MHU), Pelvic Floor Distress Inventory (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). The main endpoint was mesh safety. Secondary endpoints were anatomic (Ba point ≤ -1) and functional success.


RESULTS
In all, 111 patients with a mean age of 67 ± 9 years (range 47-89) were included in the study, and 94 (84.7%) were included in the analysis. Two intraoperative complications occurred (one bladder and one rectal injury, 2.2%). Medium-term analysis of 79 patients (84%) after 36 months showed a satisfaction rate of 98.7% (78/79), a mesh contraction rate of 5.1% (4/78), only one case of vaginal mesh exposure (1.3%), no cases of chronic pelvic pain, and a postoperative dyspareunia rate of 2.8% (1/36). The anatomic success rate of cystocele repair was 75/79 (94.9%) and a highly significant improvement was noted for symptoms and on quality of life questionnaires. Overall, 7/79 patients (8.9%) were reoperated, including 1 for hemorrhage, 1 for vaginal mesh exposure, 3 for stress urinary incontinence, and 2 for cystocele recurrence (2.5%).


CONCLUSIONS
Transvaginal cystocele repair using a lightweight transobturator polypropylene mesh was safe and efficient in the medium term. Long-term data and comparative studies are needed.
Obstetric-Gynecology Department, Caremeau University Hospital, Nîmes, France, renaud.detayrac@chu-nimes.fr.
Renaud
R
de Tayrac
Majid
M
Brouziyne
Gérard
G
Priou
Guy
G
Devoldère
Gérard
G
Marie
Joël
J
Renaudie
D000368:Aged; D000369:Aged, 80 and over; D052858:Cystocele / Q000601:surgery*; D004414:Dyspareunia / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D011126:Polypropylenes; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000601:surgery; D011446:Prospective Studies; D011474:Prosthesis Design; D011788:Quality of Life; D012008:Recurrence; D012086:Reoperation; D012720:Severity of Illness Index; D019529:Sexuality; D053825:Suburethral Slings / Q000009:adverse effects*; D013526:Surgical Mesh / Q000009:adverse effects*; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000601:surgery; D014621:Vagina / Q000601:surgery
D011126:Polypropylenes