International Urogynecology Journal

, Volume 25, Issue 3, pp 387–392 | Cite as

Nine-year objective and subjective follow-up of the ultra-lateral anterior repair for cystocele

  • Zhuoran Chen
  • Vivien Wong
  • Alex Wang
  • Kate H. Moore
Original Article

Abstract

Introduction and hypothesis

The aim of this study was to determine the long-term objective and subjective outcomes of the native tissue ultra-lateral anterior repair for cystocele.

Methods

An observational study of patients from a single tertiary centre was carried out from January 1994 to December 2006. Patients who underwent an ultra-lateral anterior repair during this period were sent the Pelvic Floor Distress Inventory (PFDI) questionnaire and invited to return for a POP-Q examination. Symptoms of prolapse, stage of cystocele recurrence and reoperation rate were assessed at follow-up.

Results

Of the 135 patients recruited, 53 also had a POP-Q examination. Mean follow-up was 9.25 years (SD 3.2). The anatomical recurrence rate was 45 % at 9.25 years, but only 26 % of patients had recurrent prolapse symptoms. Most recurrences (43 %) occurred at between 1 and 5 years. The reoperation rate for cystocele was 7.4 %.

Conclusion

Despite these rates of anatomical and symptomatic recurrence, only 7.4 % of patients underwent repeat cystocele surgery. Thus, symptomatic/anatomical recurrence of prolapse often does not mandate surgical correction. Considering that mesh complications require surgical management in approximately 10–15 %, this study supports the notion that the use of mesh in anterior vaginal repairs to reduce the risk of “recurrence” needs careful discussion with each patient.

Keywords

Cystocele Pelvic organ prolapse Native tissue repair 

Abbreviations

PFDI

Pelvic Floor Distress Inventory

POP-Q

Pelvic organ prolapse quantification

TVT

Tension-free vaginal tape

SSF

Sacrospinous fixation

Notes

Conflicts of interest

None.

References

  1. 1.
    Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89:501–506PubMedCrossRefGoogle Scholar
  2. 2.
    Nieminen K, Hiltunen R, Takala T et al (2010) Outcomes after anterior vaginal wall repair with mesh: a randomized, controlled trial with a 3 year follow-up. Am J Obstet Gynecol 203:235.e231–235.e238Google Scholar
  3. 3.
    Altman D, Väyrynen T, Engh ME, Axelsen S, Falconer C (2011) Anterior colporrhaphy versus transvaginal mesh for pelvic-organ prolapse. N Engl J Med 364:1826–1836PubMedCrossRefGoogle Scholar
  4. 4.
    Kapoor DS, Nemcova M, Pantazis K et al (2010) Reoperation rate for traditional anterior vaginal repair: analysis of 207 cases with a median 4-year follow-up. Int Urogynecol J 21:27–31PubMedCrossRefGoogle Scholar
  5. 5.
    Miedel A, Tegerstedt G, Mörlin B, Hammarström M (2008) A 5-year prospective follow-up study of vaginal surgery for pelvic organ prolapse. Int Urogynecol J 19:1593–1601CrossRefGoogle Scholar
  6. 6.
    Weber AM, Walters MD, Piedmonte MR, Ballard LA (2001) Anterior colporrhaphy: a randomized trial of three surgical techniques. Am J Obstet Gynecol 185:1299–1304, discussion 1304–1296PubMedCrossRefGoogle Scholar
  7. 7.
    Jones HW, Rock JA (2010) Te Linde’s operative gynecology, 10th edn. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  8. 8.
    Nichols DH, Randall CL (1989) Vaginal surgery, 3rd edn. Lippincott Williams & Wilkins, Baltimore, pp 247–268Google Scholar
  9. 9.
    Chmielewski L, Walters MD, Weber AM, Barber MD (2011) Reanalysis of a randomized trial of 3 techniques of anterior colporrhaphy using clinically relevant definitions of success. Am J Obstet Gynecol 205:69.e61–69.e68Google Scholar
  10. 10.
    Barber MD, Walters MD, Bump RC (2005) Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol 193:103–113PubMedCrossRefGoogle Scholar
  11. 11.
    Iglesia CB, Sokol AI, Sokol ER et al (2010) Vaginal mesh for prolapse: a randomized controlled trial. Obstet Gynecol 116:293–303PubMedCrossRefGoogle Scholar
  12. 12.
    Hendrix S, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A (2002) Pelvic organ prolapse in the Women’s Health Initiative: gravity and gravidity. Am J Obstet Gynecol 186:1160–1166PubMedCrossRefGoogle Scholar
  13. 13.
    Weemhoff M, Vergeldt TF, Notten K, Serroyen J, Kampschoer PH, Roumen FJ (2012) Avulsion of puborectalis muscle and other risk factors for cystocele recurrence: a 2-year follow-up study. Int Urogynecol J 23(1):65–71PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Maher C, Feiner B, Baessler B et al (2010) Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev CD004014Google Scholar

Copyright information

© The International Urogynecological Association 2013

Authors and Affiliations

  • Zhuoran Chen
    • 1
  • Vivien Wong
    • 1
  • Alex Wang
    • 2
  • Kate H. Moore
    • 1
  1. 1.Department of Urogynecology, St George HospitalUniversity of New South WalesSydneyAustralia
  2. 2.Statistician, National Perinatal Statistics Unit, School of Women’s and Children’s HealthUniversity of New South WalesSydneyAustralia

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