Site-specific prolapse surgery. II. Vaginal paravaginal repair augmented with either synthetic mesh or remodelling xenograft
- Richard I. ReidAffiliated withSchool of Rural MedicineSpecialist Medical Centre Email author
- , Kehui LuoAffiliated withStatistics Department, Macquarie University
Introduction and hypothesis
This study aims to answer the question, “Does tissue augmentation improve the mechanical repair of displacement cystourethrocoele?”
A retrospective cohort study comparing 108 bridging graft vaginal paravaginal repairs (89 tissue-inductive xenografts and 19 polypropylene mesh) to 59 native tissue historical controls was conducted. Main outcome measures were same-site prolapse recurrence and time to failure. Initial reliability was evaluated by chi-squared test, 10-year durability by Kaplan–Meier survival analysis and risk factors by Cox regression.
Late recurrence was 17.7% lower with augmentation (logrank test χ 2 = 8.4, p value = 0.0038 < 0.05, adjusted regression analysis χ 2 = 2.94; p value = 0.0866 <0.10), implicating collagen degeneration in repair failure.
Rebuilding the pubocervical septum, from arcus to arcus and pubic ramus to pericervical ring, satisfies the mechanical but not the metabolic hernia principles. Bridging grafts simplify technical repair (reducing prolapse persistence from 10.2% to 4.6%), and also rejuvenate adjacent connective tissue (reducing late recurrence from 22.6% to 4.9%).
KeywordsConnective tissue pathology Cystocoele aetiology Hernia/therapy Reconstructive surgical procedures/pelvis/methods Tissue engineering bioprosthesis Vaginal paravaginal repair/treatment outcome
- Site-specific prolapse surgery. II. Vaginal paravaginal repair augmented with either synthetic mesh or remodelling xenograft
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- Available under Open Access This content is freely available online to anyone, anywhere at any time.
International Urogynecology Journal
Volume 22, Issue 5 , pp 601-609
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- Connective tissue pathology
- Cystocoele aetiology
- Reconstructive surgical procedures/pelvis/methods
- Tissue engineering bioprosthesis
- Vaginal paravaginal repair/treatment outcome
- Industry Sectors