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Factors that affect recurrence after anterior colporrhaphy procedure reinforced with four-corner anchored polypropylene mesh

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Abstract

The purpose of this study was to evaluate the effectiveness of the anterior colporrhaphy procedure reinforced with four-corner anchored polypropylene mesh in patients with severe (stage III or IV) anterior vaginal prolapse. Thirty-eight consecutive women were enlisted for this prospective study. The procedure consisted of an extensive vaginal dissection to join the vesicovaginal and retropubic space and an anchoring of a polypropylene mesh patch between the two Arcus Tendineus Fasciae Pelvis in a tension-free manner. The mean age of the study group was 63 (33–80) years. The success rate was 87% (33/38) at a mean follow-up interval of 21 (12–29) months. A total of eight (100%) patients were also cured of concomitant stress incontinence (five overt and three occult type) with an additional tension-free vaginal tape (TVT) operation. During follow-up, there were five de-novo stress incontinence cases (16.7%) and four vaginal erosions of mesh (10.5%). Four clinical variables—diabetes mellitus, recurrent anterior vaginal prolapse, chronic cough and vaginal erosions of mesh—were found to have a significant correlation with an unsatisfactory surgical result with large values of hazard ratios found by survival analysis. We concluded that the anterior colporrhaphy procedure reinforced with four-corner anchored polypropylene mesh was effective for most, but failed in some patients who had specific risk factors within short convalescence periods. Concomitant stress incontinence can be successfully treated by a TVT operation in combination with the anterior colporrhaphy procedure reinforced with four-corner anchored polypropylene mesh. However, the anterior colporrhaphy procedure may itself have adverse effects on urethral sphincter function.

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Abbreviations

POPQ:

Pelvic organ prolapse quantitation

TVT:

Tension-free vaginal tape

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan

    M. J. Hung, F. S. Liu & E. S. C. Ho

  2. Department of Statistics, Tung Hai University, Taichung, Taiwan

    P. S. Shen

  3. Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan

    G. D. Chen & L. Y. Lin

Authors
  1. M. J. Hung
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  2. F. S. Liu
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  3. P. S. Shen
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  4. G. D. Chen
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  5. L. Y. Lin
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  6. E. S. C. Ho
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Corresponding author

Correspondence to M. J. Hung.

Additional information

Editorial Comment: This article is a case series of 38 patients followed for a mean of 21 months following pelvic reconstructive surgery with concomitant prolene reinforced anterior colporrhaphy. Optimal outcome was achieved in 87% of patients; however, the 10.5% mesh erosion rate and 16.7% de novo stress incontinence rate following this procedure are of concern. Synthetic vaginal mesh reinforcements should be used with caution. More data with regard to long-term sexual function is also needed.

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Hung, M.J., Liu, F.S., Shen, P.S. et al. Factors that affect recurrence after anterior colporrhaphy procedure reinforced with four-corner anchored polypropylene mesh. Int Urogynecol J 15, 399–406 (2004). https://doi.org/10.1007/s00192-004-1185-1

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  • DOI: https://doi.org/10.1007/s00192-004-1185-1

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