title: Simultaneous treatment of anterior vaginal wall prolapse and stress urinary incontinence by using transobturator four arms polypropylene mesh.
abstract: OBJECTIVE
  To evaluate the medium-term efficacy and safety of transobturator four-arm polypropylene mesh in the treatment of high-stage anterior vaginal wall prolapse and concomitant stress urinary incontinence (SUI).
  
  
  METHODS
  Between September 2010 and August 2013, a prospective single-center trial was performed to evaluate women with stage≥3 anterior vaginal wall prolapse with or without SUI who presented to Labbafinejad Hospital, Teheran, Iran, and underwent anterior vaginal wall repair with polypropylene mesh. Pre- and postoperative evaluation included history; physical examination using the Pelvic Organ Prolapse Quantification system and cough stress test, both before and after reduction of prolapsed structures; Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ); urinalysis and culture; and a postvoid residual assessment. Complications were reported at a mean of 2 years of follow-up.
  
  
  RESULTS
  A total of 71 patients underwent cystocele repair with the transobturator four-arm polypropylene mesh. Seven of the patients were lost to follow-up. There were no perioperative complications. The anatomical success rate was 87.5%. The subjective success rate was 92.1%. The PFDI and PFIQ were significantly improved after surgery (p<0.001). Among those with the simultaneous complaint of SUI, 82% were cured without any additional procedure. Three patients (4.6%) experienced vaginal mesh extrusion. Two patients (3.1%) reported worsening of dyspareunia after surgery.
  
  
  CONCLUSIONS
  The four arms polypropylene mesh is an effective device for simultaneous correction of anterior vaginal wall prolapse and SUI with a low complication rate at a medium-term follow-up. The majority of the subgroup with concomitant SUI were cured without a second simultaneous procedure.
authors.affiliation: Urology-Nephrology Research Center, Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Farzaneh
authors.initials: F
authors.lastname: Sharifiaghdas
authors.affiliation: Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: Azar
authors.initials: A
authors.lastname: Daneshpajooh
authors.affiliation: Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: Mahboubeh
authors.initials: M
authors.lastname: Mirzaei
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D052858:Cystocele / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011126:Polypropylenes; D011183:Postoperative Complications; D011446:Prospective Studies; D011788:Quality of Life; D013526:Surgical Mesh; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000150:complications / Q000601:surgery*; D014552:Urinary Tract Infections / Q000209:etiology
chemical_list: D011126:Polypropylenes
keywords: Cystocele; Dyspareunia; Polypropylene; Stress urinary incontinence