Skip to main content

Advertisement

SpringerLink
Log in

Transvaginal cystocele repair with polypropylene mesh using a tension-free technique

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

This study describes an original surgical technique for the correction of medium/high-degree cystocele using a tension-free way to apply a polypropylene mesh: the “tension-free cystocele repair” (TCR). About 218 patients were available with a mean follow-up of 38 months. This technique showed an elevated rate of anatomic correction (75.7%), a statistically significant correction of storage symptoms (48.6 vs 32.5%, p < 0.05), voiding symptoms (40.3 vs 8.3%, p < 0.05), and symptoms associated with pelvic organ prolapse (POP; 55.9 vs 11.4%, p < 0.0001), with no negative impact on ano-rectal function and, in particular, on constipation. The percentage of erosions was 12.3%, but in the group where hysterectomy was not performed, we had erosions in only 2.5%. With the exception of the Personal Relationship domain, all of the categories examined by the Prolapse Quality of Life Questionnaire showed a statistically significant improvement, which confirms the positive impact of this surgery as perceived by patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Beck RP (1990) Pelvic relaxation prolapse. In: Kase NG, Weingold AB (eds) Principles and practice of clinical gynecology. Wiley, New York, pp 677–685

    Google Scholar 

  2. Olsen AL, Smith VJ, Wergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapsed and urinary incontinence. Obstet Gynecol 89:501–506

    Article  PubMed  CAS  Google Scholar 

  3. Weber AM, Walters MD, Piedmonte MR, Ballard LA (2001) Anterior colporrhaphy: a randomized trial of three surgical techniques. Am J Obstet Gynecol 185(6):1299–1304 discussion 1304–1306)

    Article  PubMed  CAS  Google Scholar 

  4. Sand PK, Koduri S, Lobel RW, Winkler HA, Tomezsko J, Culligan PJ, Goldberg R (2001) Prospective randomized trial of polyglactin 910 mesh to prevent recurrence of cystoceles and rectoceles. Am J Obstet Gynecol 184(7):1357–1362 discussion 1362–1364)

    Article  PubMed  CAS  Google Scholar 

  5. Holley RL, Varner RE, Gleason BP et al (1995) Recurrent pelvic support defects after sacrospinous ligament fixation for vaginal vault prolapse. J Amer Coll Surg 180:444–448

    CAS  Google Scholar 

  6. Olsen AL, Smith WJ, Berstrom JO, Colling JC, Clarke AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89(4):501–506

    Article  PubMed  CAS  Google Scholar 

  7. Richardson AC, Edmonds PB, Williams NL (1981) Treatment of stress urinary incontinence due to paravaginal defect. Obstet Gynecol 57(3):357–362

    PubMed  CAS  Google Scholar 

  8. Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Karskov P, Shull BL, Smith AR (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175(1):10–17

    Article  PubMed  CAS  Google Scholar 

  9. Digesu GA, Santamato S, Kullar V, Santillo V, Digesu A, Cormio G, Loverro G, Selavggi L (2003) Validation of an Italian version of prolapse quality of life questionnaire. Eur J Obstet Gynecol Reprod Biol 106(2):184–192

    Article  PubMed  Google Scholar 

  10. DeLancey JOL (1994) Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis. Am J Obstet Gynecol 170:1713–1723

    PubMed  CAS  Google Scholar 

  11. Porges RF, Smilen SW (1994) Long-term analysis of the surgical management of pelvic support defect. Am J Obstet Gynecol 171:1518–1528

    PubMed  CAS  Google Scholar 

  12. Flood CG, Drutz HP, Waja L (1998) Anterior colporraphy reinforced with Marlex mesh for the treatment of cystocele. Int Urogynecol J 9:200–204

    Article  CAS  Google Scholar 

  13. Morley GW, DeLancey JOL (1998) Sacrospinous ligament fixation for eversion of the vagina. Am J Obstet Gynecol 158:872–881

    Google Scholar 

  14. Holley RL, Varner RE, Gleason BP et al (1995) Recurrent pelvic support defects after sacrospinous ligament fixation for vaginal vault prolapse. J Amer Coll Surg 180:444–448

    CAS  Google Scholar 

  15. Raz S, Klutke CG, Golomb J (1989) Four-corner bladder and urethral suspension for moderate cystocele. J Urol 142(3):712–715

    PubMed  CAS  Google Scholar 

  16. Miyazaki FS, Miyazaki DW (1994) Raz four-corner suspension for severe cystocele: Poor results. Int Urol J 5:94–97

    Google Scholar 

  17. Richardson AC, Edmonds PB, Williams NL (1981) Treatment of stress urinary incontinence due to paravaginal defect. Obstet Gynecol 57(3):357–362

    PubMed  CAS  Google Scholar 

  18. Benson JT (1992) Female pelvic floor disorders. Norton, New York

    Google Scholar 

  19. Birch C (2005) The use of prosthetics in pelvic reconstructive surgery. Best practice and research. Clin Obstet Gynaecol 19(1):979–991

    Google Scholar 

  20. Farrell SA, Dempsey T, Geldenhuys L (2001) Histologic examination of “fascia” used in colporraphy. Obstet Gynecol 98(5Pt1):794–798

    Article  PubMed  CAS  Google Scholar 

  21. Barber MD, Visco AG, Weidner AC, Amudsen CL, Bump RC (2000) Bilateral uterosacral ligament vaginal vault suspension with site-specific endopelvic fascia defect repair for the treatment of pelvic organ prolapse. Am J Obstet Gynecol 2 183(6):1402–1410

    Article  CAS  Google Scholar 

  22. Nicita G (1998) A new operation for genitourinary prolapse. J Urol 160(3 Pt 1):741–745

    PubMed  CAS  Google Scholar 

  23. Mage P (1999) Interposition of a synthetic mesh by vaginal approach in the cure of genital prolapse. J Gynecol Obstet Biol Reprod (Paris) 28(8):825–829

    CAS  Google Scholar 

  24. Migliari R, Usai E (1999) Treatment results using a mixed fiber mesh in patients with grade IV cystocele. J Urol 161(4):1255–1258

    Article  PubMed  CAS  Google Scholar 

  25. Dwyer PL, O’Reilly BA (2004) Transvaginal repair of anterior and posterior compartment prolapse with Atrium polypropylene mesh. BJOG 111(8):831–836

    Article  PubMed  Google Scholar 

  26. Gomelsky A, Rudy DC, Dmochowski RR (2004) Porcine dermis interposition graft for repair of high grade anterior compartment defects with or without concomitant pelvic organ prolapse procedures. J Urol 171(4):1581–1584

    Article  PubMed  Google Scholar 

  27. Milani R, Salvatore S, Soligo M, Pifarotti P, Meschia M, Cortese M (2005) Functional and anatomical outcome of anterior and posterior vaginal prolapse repair with prolene mesh. BJOG 112(1):107–111

    Article  PubMed  Google Scholar 

  28. Gandhi S, Goldberg RP, Kwon C, Koduri S, Beaumont JL, Abramov Y, Sand PK (2005) A prospective randomized trial using solvent dehydrated fascia lata for the prevention of recurrent anterior vaginal wall prolapse. Am J Obstet Gynecol 192(5):1649–1654

    Article  PubMed  Google Scholar 

  29. De Tayrac R, Deffieux X, Gervaise A, Chauveaud-Lambling A, Fernandez H (2006) Long-term anatomical and functional assessment of trans-vaginal cystocele repair using a tension-free polypropylene mesh. Int Urogynecol J Pelvic Floor Dysfunct 17(5):483–488

    Article  PubMed  Google Scholar 

  30. De Tayrac R, Gervaise A, Chauveaud A et al (2005) Tension-free polypropylene mesh for vaginal repair of anterior vaginal wall prolapse. J Reprod Med 50:75–80

    PubMed  Google Scholar 

  31. Rogers RG, Kammesse Doak D, Darrow A et al (2004) Sexual function after surgery for stress incontinence and/or pelvic organ prolapse. A multicenter prospective study. Am J Obstet Gynecol 191:206–210

    Article  PubMed  Google Scholar 

  32. Milani R, Salvatore S, Soligo M et al (2005) Functional and anatomical outcome of anterior and posterior vaginal prolapse repair with prolene mesh. BJOG 112:107–111

    Article  PubMed  Google Scholar 

  33. Eglin G, Ska JM, Serres X (2003) Transobturator subvesical mesh. Tolerance and short-term results of a 103 cases continuous series. Gynecol Obstet Fertil 31(1):14–19

    Article  PubMed  CAS  Google Scholar 

  34. Debodinance P, Cosson M, Burlet G et al (1999) Tolerance of synthetic tissues and vaginal surgery. Report of 287 cases. J Gynecol Obstet Biol Reprod (Paris) 28(3):216–224

    CAS  Google Scholar 

  35. Collinet P, Belot F, Debodinance P et al (2006) Transvaginal mesh technique for pelvic organ prolapse repair: mesh exposure management and risk factors. Int Urogynecol J 17:315–320

    Article  Google Scholar 

  36. Achtari C, Hiscock R, O’Reilly BA, Schierlitz L, Dwyer PL (2005) Risk factors for mesh erosion after transvaginal surgery using polypropylene (Atrium) or composite polypropylene/polyglactin 910 (Vypro II) mesh. Int Urogynecol J 16:389–394

    Article  Google Scholar 

  37. Visco AG, Weidner AC, Barber MD, Myers ER, Cundiff GW, Bump RC (2001) Vaginal mesh erosion after abdominal sacral colpopexy. Am J Obstet Gynecol 184:297–302

    Article  PubMed  CAS  Google Scholar 

  38. Beck RP, Mc Cormick S, Nordstrom L (1991) A 25-years experience with 519 anterior colporraphy procedures. Obstet Gynecol 78(6):1011–1018

    PubMed  CAS  Google Scholar 

  39. Borstad E, Rud T (1991) The risk of developing stress urinary incontinence after vaginal repair in continent women. A clinical and urodynamic follow-up study. Acta Obstet Gynecol Scand 70(6):501–506

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Urogynecological Department, S. Carlo-IDI Hospital, Rome, Italy

    M. Cervigni, F. Natale, C. La Penna, M. Panei & A. Mako

  2. Section of Gynecology and Obstetrics, Department of Surgery, University of Rome “Tor Vergata”, Rome, Italy

    C. La Penna

Authors
  1. M. Cervigni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Natale
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. La Penna
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Panei
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Mako
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. Natale.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cervigni, M., Natale, F., La Penna, C. et al. Transvaginal cystocele repair with polypropylene mesh using a tension-free technique. Int Urogynecol J 19, 489–496 (2008). https://doi.org/10.1007/s00192-007-0486-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-007-0486-6

Keywords

Search

Navigation