title: Cystocele Repair by Autologous Rectus Fascia Graft: the Pubovaginal Cystocele Sling.
abstract: OBJECTIVE
  The autologous rectus fascia pubovaginal sling has been a safe and effective means of correcting stress urinary incontinence. We tested the feasibility of using a larger graft to correct cystocele with or without stress urinary incontinence.
  
  
  METHODS
  Between January 2006 and October 2010, 30 patients with symptomatic cystocele underwent the pubovaginal cystocele sling procedure, including 14 with and 16 without concomitant stress urinary incontinence. The technique is a modification of the standard pubovaginal sling procedure. A large trapezoidal (major base 6 cm, minor base 4 cm and height 5 cm) rectus fascia graft is used with 4 instead of 2 sutures to suspend the graft corners. The 2 sutures at the level of the mid urethra are tied above the rectus muscles in a tension-free manner while the 2 sutures at the level of the cervical fold are tied with tension. Data on anatomical outcomes (Baden-Walker classification), functional outcomes (PFIQ-7), post-void residual urine volume and urinary tract infection were prospectively collected.
  
  
  RESULTS
  At a mean followup of 62.6 months (range 46 to 98) there was no recurrence in the anterior compartment. There was 1 recurrence involving the apical and posterior compartments. All patients reported a statistically significant improvement in PFIQ-7 score. When present preoperatively, post-void residual urine volume, urinary tract infection and stress urinary incontinence ceased in all cases. The only complication was donor site wound dehiscence without fascial involvement.
  
  
  CONCLUSIONS
  The autologous pubovaginal cystocele sling seems to be a safe, effective technique to correct cystocele with or without stress urinary incontinence.
authors.affiliation: Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy. Electronic address: luigicormio@libero.it.
authors.forename: Luigi
authors.initials: L
authors.lastname: Cormio
authors.affiliation: Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Mancini
authors.affiliation: Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Liuzzi
authors.affiliation: Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lucarelli
authors.affiliation: Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Carrieri
mesh_terms: D064592:Autografts; D052858:Cystocele / Q000150:complications / Q000601:surgery*; D005205:Fascia / Q000637:transplantation*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D017568:Rectus Abdominis; D053825:Suburethral Slings; D014550:Urinary Incontinence, Stress / Q000150:complications / Q000601:surgery
keywords: autografts; cystocele; prolapse; stress; urinary bladder; urinary incontinence