title: Anterior six arms prolene mesh for high stage vaginal prolapse: five years follow-up.
abstract: BACKGROUND
  In high stage vaginal prolapse, recurrence risk patients, anterior and apical defects need to be addressed in the same procedure. The pre-molded commercial mesh kits are expensive and not always available. Alternative effective and safe treatment ways, with lower costs are desirable.
  
  
  OBJECTIVE
  To present long term follow-up of patients treated with a homemade mesh shape to correct high stage prolapses.
  
  
  METHODS
  We describe prospectively 18 patients with anterior and apical vaginal prolapses, stages III and IV, repaired using this specific design of mesh. All patients were submitted to pre-operative clinical evaluation and urodynamics. Prolapse was classified using the pelvic organ prolapse quantification (POP-Q).
  
  
  METHODS
  Prolapse surgery, using a six arms prolene mesh, through a single anterior vaginal incision.
  
  
  METHODS
  POP-Q, patients satisfaction, descriptive statistical analysis.
  
  
  RESULTS
  Between February 2009 and Oct 2010, 18 consecutive women underwent the above-mentioned surgery. Mean age was 68 years. At a mean follow-up of 4 years (5 to 5.8 years), 16 (89%) patients were continent, mean Ba point came from +4.7cm to -2.5cm, mean C point from +2.8cm to -6.6cm and mean Bp point from +1.3 to -1.7cm. There were two (11%) objective failures, but all the patients were considered success subjectively. There were two cases of mesh vaginal extrusion.
  
  
  CONCLUSIONS
  The homemade six arms prolene mesh allows concomitant correction of anterior and apical prolapses, through a single anterior vaginal incision, being an effective, safe and affordable treatment option when mesh is needed.
authors.affiliation: Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil.|Serviço de Uroginecologia, Maternidade Cachoeirinha, São Paulo, SP, Brasil.
authors.forename: Luis Gustavo M de
authors.initials: LGM
authors.lastname: Toledo
authors.affiliation: Serviço de Uroginecologia, Maternidade Cachoeirinha, São Paulo, SP, Brasil.
authors.forename: André
authors.initials: A
authors.lastname: Costa-Matos
authors.affiliation: Serviço de Uroginecologia, Maternidade Cachoeirinha, São Paulo, SP, Brasil.
authors.forename: Susane Mey
authors.initials: SM
authors.lastname: Hwang
authors.affiliation: Serviço de Uroginecologia, Maternidade Cachoeirinha, São Paulo, SP, Brasil.
authors.forename: Raquel Dória Ramos
authors.initials: RDR
authors.lastname: Richetti
authors.affiliation: Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil.
authors.forename: Silvia S
authors.initials: SS
authors.lastname: Carramão
authors.affiliation: Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil.
authors.forename: Antônio P F
authors.initials: APF
authors.lastname: Auge
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D013526:Surgical Mesh; D013997:Time Factors; D014549:Urinary Incontinence / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics; D014596:Uterine Prolapse / Q000601:surgery*; D014621:Vagina / Q000601:surgery*
keywords: Pelvic Organ Prolapse; Surgical Mesh ; Surgical Procedures, Operative