title: 3-year results of transvaginal cystocele repair with transobturator four-arm mesh: A prospective study of 105 patients.
abstract: OBJECTIVE
  To evaluate the long-term efficacy and safety of transobturator four-arm mesh for treating cystoceles.
  
  
  METHODS
  In this prospective study, 105 patients had a cystocele corrected between January 2004 and December 2008. All patients had a symptomatic cystocele of stage ⩾2 according to the Baden-Walker halfway stratification. We used only the transobturator four-arm mesh kit (Surgimesh®, Aspide Medical, France). All surgical procedures were carried out by the same experienced surgeon. The patients' characteristics and surgical variables were recorded prospectively. The anatomical outcome, as measured by a physical examination and postoperative stratification of prolapse, and functional outcome, as assessed by a questionnaire derived from the French equivalents of the Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire and the Pelvic Organ Prolapse-Urinary Incontinence-Sexual Questionnaire, were considered as the primary outcome measures. Peri- and postoperative complications constituted the secondary outcome measures.
  
  
  RESULTS
  At 36 months after surgery the anatomical success rate (stage 0 or 1) was 93%. On a functional level, all the scores of quality of life and sexuality were improved. The overall satisfaction score (visual analogue scale) was 71.4%. There were no perioperative adverse events. Mesh erosion was reported in 7.6% and mesh retraction in 5.7% of the patients.
  
  
  CONCLUSIONS
  If the guidelines and precautions are followed, vaginal prosthetic surgery for genitourinary prolapse has shown long-term benefits. It provides excellent results both anatomically and functionally. However, complications are not negligible and some are specific to prosthetic surgery.
authors.affiliation: Department of Obstetrics and Gynecology, Aziza Othmana Hospital, Tunis, Tunisia.
authors.forename: Moez
authors.initials: M
authors.lastname: Kdous
authors.affiliation: Department of Obstetrics and Gynecology, Aziza Othmana Hospital, Tunis, Tunisia.
authors.forename: Fethi
authors.initials: F
authors.lastname: Zhioua
keywords: Cystocele; Genital prolapse; PFDI, Pelvic Floor Distress Inventory; PFDIQ, Pelvic Floor Distress Impact Questionnaire; PPISQ-12, Pelvic Organ Prolapse/Urinary Incontinence-Sexual Questionnaire; Polypropylene mesh; QoL, quality of life; SUI, stress urinary incontinence; TAPF, tendinous arch of the pelvic fascia; TOT, transobturator tape; TVT, tension-free vaginal tape; Transvaginal mesh; VAS, visual analogue scale