[Is the use of synthetic mesh by vaginal route decrease the risk of cystocele recurrence? Clinical practice guidelines].
BACKGROUND
The use of prosthetic surgery by vaginal route has been widely used to try to reduce the risk of prolapse recurrence in the surgical treatment of vaginal cystoceles. Specific complications including type of erosion have led to randomized studies comparing surgery by vaginal route with and without use of Mesh.


METHODS
This work is based on a systematic review of the literature (PubMed, Medline, Cochrane Library, Cochrane database of systemactic reviews, EMBASE) for meta-analyzes, randomized trials, registries, literature reviews, controlled studies and major not controlled studies, published on the subject. Its implementation has followed the methodology of the HAS on the recommendations for clinical practice, with a scientific argument (with the level of evidence, NP) and a recommendation grade (A, B, C, and professional agreement (AP)).


RESULTS
The use of inter-vesicovaginal synthetic mesh improves the anatomical result compared to the autologous surgery for the treatment of cystocele (NP1). However, there is no difference in the functional outcome and there is an increase in the number of reoperations related to specific complications, including vaginal erosions.


CONCLUSIONS
If the use of inter-vesicovaginal synthetic mesh improves the anatomical result compared to the autologous surgery for the treatment of cystocele (NP1), no difference in functional outcome and the increased number of related reoperations specific complications including vaginal erosions, do not argue for the systematic use of mesh in the treatment of primary cystocele. It must be discussed case by case basis taking into account a risk-benefit uncertain at long-term (grade B). Its use should be supported by additional studies focused on specific populations at risk of recurrence. © 2016 Published by Elsevier Masson SAS.
Service d'urologie, CHU Nantes, place Alexis-Ricordeau, 44093 Nantes Cedex 1, France. Electronic address: loic.lenormand@chu-nantes.fr.
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Le Normand
Service de gynécologie obstétrique, hôpital Antoine-Béclère, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France.
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Deffieux
Polyclinique Côte-Basque-Sud, 7, rue Léonce-Goyetche, 64500 Saint-Jean-de-Luz, France.
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Donon
Service de gynécologie, CHRU Carémeau, rue du Professeur-Debré, 30029 Nîmes Cedex 9, France.
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Fatton
Service d'urologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
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Cour
D052858:Cystocele / Q000453:epidemiology / Q000517:prevention & control / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods / Q000592:standards*; D006801:Humans; D017410:Practice Guidelines as Topic; D011474:Prosthesis Design; D012008:Recurrence; D018570:Risk Assessment; D013526:Surgical Mesh; D014621:Vagina
Cystocele; Cystocèle; Guidelines; Pelvic organ prolapse; Prolapsus génital; Prothèse synthétique; Recommandations; Synthetic mesh; Vaginal surgery; Voie vaginale