International Urogynecology Journal

, Volume 24, Issue 2, pp 249–254

Clinical efficacy of a trocar-guided mesh kit for repairing lateral defects

  • Marion Ek
  • Daniel Altman
  • Jonas Gunnarsson
  • Christian Falconer
  • Gunilla Tegerstedt
Original Article


Introduction and hypothesis

The optimal surgery for lateral defects is not well defined. Our objective was to assess the effects of anterior trocar-guided transvaginal mesh repair versus anterior colporrhaphy in women with lateral defects.


This subanalysis from a randomized controlled trial of mesh kit versus anterior colporrhaphy assessed 99 patient diagnosed at baseline with lateral defects in the anterior vaginal wall. Thirty-nine patients underwent anterior colporrhaphy and 60 anterior trocar-guided transvaginal mesh surgery.


One year after surgery, a persistent lateral defect was significantly more common after colporrhaphy compared with transvaginal mesh [11/32 (34.4 %) vs 1/42 (2.4 %), risk ratio (RR) 14.4, 95 % confidence interval (CI) 2.0–106.1; P < 0.001)] However, there were no significant differences between treatment groups with regard to subjective symptoms as reflected by the overall Urogenital Distress Inventory scores, with mean difference from baseline 37.3 ± 50.6 in the colporrhaphy group vs 39.0 ± 45.8 in the mesh group (p = 0.61).


Use of a transvaginal mesh kit increases the odds for anatomical correction of lateral defects compared with anterior colporrhaphy but does not necessarily improve lower urinary tract symptoms.


Anterior vaginal prolapse colporrhaphy Lateral defect Mesh 


  1. 1.
    Weber AM, Richter HE (2005) Pelvic organ prolapse. Obstet Gynecol 106(3):615–634PubMedCrossRefGoogle Scholar
  2. 2.
    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 1304–6PubMedCrossRefGoogle Scholar
  3. 3.
    Sand PK, Koduri S, Lobel RW et al (2001) Prospective randomized trial of polyglactin 910 mesh to prevent recurrence of cystoceles and rectoceles. Am J Obstet Gynecol 184(7):1357–1362, discussion 1362–4PubMedCrossRefGoogle Scholar
  4. 4.
    Rodriguez LV, Bukkapatnam R, Shah SM, Raz S (2005) Transvaginal paravaginal repair of high-grade cystocele central and lateral defects with concomitant suburethral sling: report of early results, outcomes, and patient satisfaction with a new technique. Urology 66(5 Suppl):57–65PubMedCrossRefGoogle Scholar
  5. 5.
    Miedel A, Tegerstedt G, Morlin B, Hammarstrom M (2008) A 5-year prospective follow-up study of vaginal surgery for pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 19(12):1593–1601PubMedCrossRefGoogle Scholar
  6. 6.
    Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89(4):501–506PubMedCrossRefGoogle Scholar
  7. 7.
    Fialkow MF, Newton KM, Weiss NS (2008) Incidence of recurrent pelvic organ prolapse 10 years following primary surgical management: a retrospective cohort study. Int Urogynecol J Pelvic Floor Dysfunct 19(11):1483–1487PubMedCrossRefGoogle Scholar
  8. 8.
    White A (1909) Cystocele. JAMA 21:1707–1710CrossRefGoogle Scholar
  9. 9.
    Richardson AC, Lyon JB, Williams NL (1976) A new look at pelvic relaxation. Am J Obstet Gynecol 126(5):568–573PubMedGoogle Scholar
  10. 10.
    Young SB, Daman JJ, Bony LG (2001) Vaginal paravaginal repair: one-year outcomes. Am J Obstet Gynecol 185(6):1360–1366, discussion 1366–7PubMedCrossRefGoogle Scholar
  11. 11.
    Maher C, Feiner B, Baessler K, Adams EJ, Hagen S, Glazener CMA (2007) Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev 2010;(4):CD004014.Google Scholar
  12. 12.
    Altman D, Vayrynen T, Engh ME, Axelsen S, Falconer C (2011) Anterior colporrhaphy versus transvaginal mesh for pelvic-organ prolapse. N Engl J Med 364(19):1826–1836.PubMedCrossRefGoogle Scholar
  13. 13.
    Bump RC, Mattiasson A, Bo K et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175(1):10–17PubMedCrossRefGoogle Scholar
  14. 14.
    Barber MD, Brubaker L, Nygaard I et al (2009) Defining success after surgery for pelvic organ prolapse. Obstet Gynecol 114(3):600–609PubMedCrossRefGoogle Scholar
  15. 15.
    Uebersax JS, Wyman JF, Shumaker SA, McClish DK, Fantl JA (1995) Short forms to assess life quality and symptom distress for urinary incontinence in women: the incontinence impact questionnaire and the urogenital distress inventory. Continence program for women research group. Neurourol Urodyn 14(2):131–139PubMedCrossRefGoogle Scholar
  16. 16.
    Shumaker SA, Wyman JF, Uebersax JS, McClish D, Fantl JA (1994) Health-related quality of life measures for women with urinary incontinence: the incontinence impact questionnaire and the urogenital distress inventory. Continence Program in Women (CPW) research group. Qual Life Res 3(5):291–306PubMedCrossRefGoogle Scholar
  17. 17.
    Larson KA, Luo J, Guire KE, Chen L, Ashton-Miller JA, DeLancey JO (2012) 3D analysis of cystoceles using magnetic resonance imaging assessing midline, paravaginal, and apical defects. Int Urogynecol J 23(3):285–293PubMedCrossRefGoogle Scholar
  18. 18.
    Colombo M, Milani R, Vitobello D, Maggioni A (1996) A randomized comparison of Burch colposuspension and abdominal paravaginal defect repair for female stress urinary incontinence. Am J Obstet Gynecol 175(1):78–84PubMedCrossRefGoogle Scholar
  19. 19.
    Demirci F, Ozdemir I, Somunkiran A, Gul OK, Gul B, Doyran GD (2007) Abdominal paravaginal defect repair in the treatment of paravaginal defect and urodynamic stress incontinence. J Obstet Gynaecol 27(6):601–604PubMedCrossRefGoogle Scholar
  20. 20.
    Swift SE, Tate SB, Nicholas J (2003) Correlation of symptoms with degree of pelvic organ support in a general population of women: what is pelvic organ prolapse? Am J Obstet Gynecol 189(2):372–377, discussion 377–9PubMedCrossRefGoogle Scholar
  21. 21.
    Morse AN, O'Dell K, Howard AE, Baker SP, Aronson MP, Young SB (2007) Midline anterior repair alone vs anterior repair plus vaginal paravaginal repair: a comparison of anatomic and quality of life outcomes. Int Urogynecol J Pelvic Floor Dysfunct 18(3):245–249PubMedCrossRefGoogle Scholar
  22. 22.
    Whiteside JL, Barber MD, Paraiso MF, Hugney CM, Walters MD (2004) Clinical evaluation of anterior vaginal wall support defects: interexaminer and intraexaminer reliability. Am J Obstet Gynecol 191(1):100–104PubMedCrossRefGoogle Scholar
  23. 23.
    Dietz HP, Pang S, Korda A, Benness C (2005) Paravaginal defects: a comparison of clinical examination and 2D/3D ultrasound imaging. Aust N Z J Obstet Gynaecol 45(3):187–190PubMedCrossRefGoogle Scholar
  24. 24.
    Youngblood JP (1993) Paravaginal repair for cystourethrocele. Clin Obstet Gynecol 36(4):960–966PubMedCrossRefGoogle Scholar
  25. 25.
    Segal JL, Vassallo BJ, Kleeman SD, Silva WA, Karram MM (2004) Paravaginal defects: prevalence and accuracy of preoperative detection. Int Urogynecol J Pelvic Floor Dysfunct 15(6):378–383, discussion 383PubMedCrossRefGoogle Scholar
  26. 26.
    Richardson AC, Edmonds PB, Williams NL (1981) Treatment of stress urinary incontinence due to paravaginal fascial defect. Obstet Gynecol 57(3):357–362PubMedGoogle Scholar
  27. 27.
    Delancey JO (2002) Fascial and muscular abnormalities in women with urethral hypermobility and anterior vaginal wall prolapse. Am J Obstet Gynecol 187(1):93–98PubMedCrossRefGoogle Scholar
  28. 28.
    Summers A, Winkel LA, Hussain HK, DeLancey JO (2006) The relationship between anterior and apical compartment support. Am J Obstet Gynecol 194(5):1438–1443PubMedCrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2012

Authors and Affiliations

  • Marion Ek
    • 1
    • 6
  • Daniel Altman
    • 2
    • 3
  • Jonas Gunnarsson
    • 4
  • Christian Falconer
    • 2
  • Gunilla Tegerstedt
    • 5
  1. 1.Division of Obstetrics and Gynaecology, Department of Clinical Science and EducationSödersjukhuset, Karolinska InstitutetStockholmSweden
  2. 2.Division of Obstetrics and Gynecology, Department of Clinical ScienceDanderyd Hospital, Karolinska InstitutetStockholmSweden
  3. 3.Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
  4. 4.Department of Obstetrics and GynecologySahlgrenska University HospitalGöteborgSweden
  5. 5.Unit of Obstetrics and Gynecology, CLINTECKarolinska University Hospital at Huddinge, Karolinska InstitutetStockholmSweden
  6. 6.Department of Obstetrics and GynecologySödersjukhusetStockholmSweden

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