, Volume 9, Issue 4, pp 200-204

Anterior colporrhaphy reinforced with Marlex mesh for the treatment of cystoceles

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Abstract

This study assesses the use of Marlex mesh in conjunction with anterior colporrhaphy for the correction of cystocele with or without urinary stress incontinence. A retrospective review was carried out of 12 years' experience with 142 patients undergoing a modified anterior colporrhaphy reinforced with Marlex mesh. All patients had preoperative urodynamics. Pre- and post-operative symptoms were compared and patients were examined for recurrent prolapse and mesh complications. Mean follow-up time was 3.2 years. No patients experienced recurrent anterior vaginal wall prolapse. Three patients developed mesherosions into the vagina. There was a 74% success rate in the treatment of urinary stress incontinence. Marlex mesh used as a reinforcement for anterior colporrhaphy is effective in preventing recurrent anterior wall descent, with minimal complications.

Editorial Comment: This is a retrospective review of a 12-year experience utilizing Marlex mesh placed and stabilized with interrupted sutures below the urethrovesical junction, combined with a traditional anterior colporrhaphy to treat symptomatic prolapse. The authors report a 100% success rate, in that no patient had recurrence of anterior wall prolapse greater than stage II. The procedure also was effective in treating concurrent genuine stress incontinence, with a respectable 74% success rate at 1 year postoperative urodynamic evaluation in a small subset of patients who received both pre- and postoperative testing. The erosion rate of the mesh into the vagina was 2%, compared to previously reported rates of 12.5%; 3.5% of patients experienced postoperative dyspareunia. Although these results in a large group of patients over an extended follow-up period appear promising, the description of the actual surgical procedure sounds more like a suburethral sling than a procedure that would give support to the entire length of the anterior vaginal wall. Studies by other centers are needed to confirm these findings.