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Traitement des prolapsus vaginaux antérieurs par voie vaginale avec implant de derme porcin fixé en transobturateur

Transvaginal treatment of anterior vaginal prolapse with a transobturator fixation of porcin collagen implant

  • Article Original / Original Article
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Pelvi-périnéologie

Résumé

Objectif

Évaluer la faisabilité et les résultats à court et moyen termes, du traitement des cystocèles par voie vaginale avec implant de collagène amarré en transobturateur (TOT).

Matériels et méthodes

Étude rétrospective menée sur 46 patientes, d’âge moyen de 71 ans [52–84], porteuses d’une cystocèle de grades 2 à 4. L’évaluation postopératoire a été effectuée à un mois, six mois, puis de façon annuelle. La technique standardisée a consisté en la mise en place d’une prothèse de Pelvicol™ de 4 × 7 cm fixée aux angles antéroexternes par voie TOT. Les résultats anatomiques ont été définis comme optimaux en cas de stade inférieur ou égal à 1, et satisfaisants en cas de stade 2 non symptomatique. Les échecs ont été définis par la récidive d’un prolapsus symptomatique et/ou stade supérieur ou égal à 3.

Résultats

L’implantation de la plaque de Pelvicol™ a été faisable dans tous les cas. Aucune complication peropératoire n’a été observée. Le recul moyen a été de 25 mois [12–36]. Les complications postopératoires observées comportaient un cas de plicature urétérale et un cas d’expulsion de plaque, secondaire à un hématome. Un geste associé a été réalisé dans 78,3 % des cas. Trois récidives ont été observées, une à un mois et deux tardives: 6 et 12 mois. Avec un recul moyen de 25 mois, une seule patiente a nécessité une reprise (2 %), 93,5 % des patientes ont eu un résultat anatomique optimal, et 98 % un résultat satisfaisant.

Conclusion

Cette technique est reproductible, peu de complications ont été observées. Les résultats à moyen terme sont satisfaisants. L’appréciation à long terme sera poursuivie.

Abstract

Objective

To assess the feasibility and efficacy of a porcine skin collagen (Pelvicol™) implant by a vaginal route and a transobturator (TOT) fixation for the treatment of cystoceles.

Patients and methods

In a retrospective study, 46 patients with vaginal prolapse stages 2 to 4 underwent anterior colporrhaphy associated Pelvicol™ implantation to correct their bladder prolapse: the bladder was dissected via a transvaginal approach and the graft was fixed laterally by a TOT route. The patients were reviewed at 1.6 month and every year. An anatomic success was defined by a stage inferior or equal to 1, and satisfactory by an asymptomatic stage 2. A failure was defined by a symptomatic prolapse and/or a stage superior or equal to 3.

Results

Porcine skin collagen implantation was feasible in every case. Mean follow-upwas 25 months [12–36]. No vessel and no bladder injury occurred during the procedure. The postoperative complications were a case of urethral plicature and a spontaneous expulsion of the graft due to a hematoma. An associated procedure was necessary in 78.3%of cases. We observed three cases of recurrences with only one surgical reintervention (at the 12th month for an invalidating stage 3). Forty-three (93.5%) patients had a complete resolution of the prolapse and 98% a good functional result.

Conclusion

The technique is reproducible, and a low rate of complication was observed. The median-term results are very satisfactory and need to be confirmed by a long-term evaluation.

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Authors and Affiliations

  1. Service d’urologie, CHU Charles-Nicolle, 1, rue de Germont, F-76031, Rouen cedex, France

    L. Rouache, M. Cherif, J. Seror, G. Descargues & P. Grise

  2. Service d’urologie, CHU Côte-de-Nacre, avenue de la Côte-de-Nacre, F-14033, Caen cedex 9, France

    S. Le Toquin

  3. Clinique Saint-Hilaire, 2, place Saint-Hilaire, F-76000, Rouen, France

    G. Descargues

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  1. L. Rouache
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  2. M. Cherif
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Correspondence to L. Rouache.

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Rouache, L., Cherif, M., Le Toquin, S. et al. Traitement des prolapsus vaginaux antérieurs par voie vaginale avec implant de derme porcin fixé en transobturateur. Pelv Perineol 4, 178–183 (2009). https://doi.org/10.1007/s11608-009-0252-y

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