Outcomes of anterior vaginal wall repair using polypropylene mesh

Czech version

Authors: M. Huser; M. Pastorčáková; I. Belkov; K. Sedláková
Authors‘ workplace: Gynekologicko- porodnická klinika LF MU a FN, Brno, přednosta prof. MUDr. P. Ventruba, DrSc.
Published in: Ceska Gynekol 2012; 77(5): 407-413

Overview

Introduction:
Pelvic organ prolapse (POP) is a major health concern especially in the elderly women. Anterior vaginal wall prolapse (AWP) represents the most common form of POP with reoperation rate 30–40% when primary treated by anterior colporrhaphy. Modern surgical techniques of POP repair uses polypropylene (PP) mesh implants to better support pelvic structures and lower the risk of recurrence. Aim of our study was to assess the safety and efficacy of anterior vaginal wall prolapse repair using PP mesh system NAZCA TC (Promedon). The kit consists of preformed PP mesh anchored to pelvic structures by two needle inserters via pre-pubic and trans-obturator route.

Methods:
From January 2010 to February 2011, 21 patients with stage III/IV AWP underwent transvaginal repair with implantation of PP mesh. The stage of POP measured according to POP-Q system, surgery length, blood loss and complications has been evaluated six month after the surgery. Surgery has been assessed as successful when POP stage 0/I o has been reached. In 42.9% of patients AWP repair was combined with other procedures: vaginal hysterectomy or posterior vaginal repair. (Statistical evaluation was done by Wilcoxon test.)

Results:
The average age of operated women was 62.4±9.4 years, average body mass index was 27.5±4.1 kg/m², with overall parity of 2.2±1.4 children. The surgery time was 64.0±26.0 minutes with average blood loss of 185.0±17,0 ml. No serious per-operating complication has been recorded. The objective cure rate at 6 months was 90.5%. Statistically significant difference in the position of points Aa, Ba and C (p<0,05) has been observed. Difference in the position of other POP-Q points has not been statistically significant. Post operatively one case of small mesh erosion managed by observation only has been documented.

Conclusion:
Transvaginal repair of AWP with polypropylene mesh is an effective and safe technique in the hands of surgeon experienced in classical POP reconstruction techniques. For the assessment of long term efficacy the further follow-up of patients is necessary.

Key words:
pelvic organ prolapse, surgical treatment, polypropylene mesh, efficacy, complications.

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