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Cystocele repair by vaginal route: comparison of three different surgical techniques of mesh placement

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Abstract

Introduction and hypothesis

Different techniques of mesh placement for cystocele repair are known. Our goal was to compare anatomical and functional outcomes of three different techniques of mesh placement over a 3-year follow-up.

Methods

Between March 2003 and June 2004, 230 patients (stage 2–4 pelvic organ prolapse (POP)) were included in a prospective study. For cystocele repair, mesh was implanted either with two arms into the retropubic space (RP) or with two to four arms into the obturator foramen (TO), or fixed to the arcus tendineous fascia pelvis (FG).

Results

Patients' distribution is as follows: 142 TO, 32 RP, and 31 FG. Anatomical success (cystocele < stage 2 in the POP staging system) was clearly poorer after the retropubic free technique, with success rates of 69% (RP), 90.1% (TO), and 96.6% (FG) (p = 0.004). POP distress inventory (p < 0.005) and POP impact questionnaire scores were both significantly poorer after RP.

Conclusions

RP technique is less effective than TO and FG techniques.

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References

  1. Benson J, Lucente V, McClellan E (1996) Vaginal versus abdominal reconstructive surgery for the treatment of pelvic support defects: a prospective randomized study with long-term outcome evaluation. Am J Obstet Gynecol 175:1418–1422

    Article  PubMed  CAS  Google Scholar 

  2. Julian TM (1996) The efficacy or Marlex mesh in the repair of severe, recurrent vaginal prolapse of the anterior midvaginal wall. Am J Obstet Gynecol 175:1472–1475

    Article  PubMed  CAS  Google Scholar 

  3. Hiltunen R, Nieminen K, Takala T, Heiskanen E, Merikari M, Niemi K, Heinonen PK (2007) Low-weight polypropylene mesh for anterior vaginal wall prolapse: a randomized controlled trial. Obstet Gynecol 110(2 Pt 2):455–462

    Article  PubMed  Google Scholar 

  4. Sivaslioglu AA, Unlubilgin E, Dolen I (2008) A randomized comparison of polypropylene mesh surgery with site-specific surgery in the treatment of cystocoele. Int Urogynecol J Pelvic Floor Dysfunct 19(4):467–471, Epub 2007 Sep 28

    Article  PubMed  CAS  Google Scholar 

  5. Nguyen JN, Burchette RJ (2008) Outcome after anterior vaginal prolapse repair: a randomized controlled trial. Obstet Gynecol 111(4):891–898

    Article  PubMed  Google Scholar 

  6. de Tayrac R, Devoldere G, Renaudie J, Villard P, Guilbaud O, Eglin G, French Ugytex Study Group (2007) Prolapse repair by vaginal route using a new protected low-weight polypropylene mesh: 1-year functional and anatomical outcome in a prospective multicentre study. Int Urogynecol J Pelvic Floor Dysfunct 18(3):251–256

    Article  PubMed  Google Scholar 

  7. de Tayrac R, Chauveaud-Lambling A, Fernandez D, Fernandez H (2003) Quality of life instruments for women with pelvic organ prolapse. J Gynecol Obstet Biol Reprod (Paris) 32:503–523

    Google Scholar 

  8. Barber MD, Kuchibhatla MN, Pieper CF, Bump RC (2001) Psychometric evaluation of 2 comprehensive condition-specific quality of life instruments for women with pelvic floor disorders. Am J Obstet Gynecol 185:1388–1395

    Article  PubMed  CAS  Google Scholar 

  9. Haab F, Richard F, Amarenci G, Coloby P, Arnould B, Benmedjahed K, Guillemin I, Grise P (2008) Comprehensive evaluation of bladder and urethral dysfunction symptoms: development and psychometric validation of the Urinary Symptom Profile (USP) questionnaire. Urology 71(4):646–656

    Article  PubMed  Google Scholar 

  10. de Tayrac R, Gervaise A, Chauveaud A, Fernandez H (2005) Tension-free polypropylene mesh for vaginal repair of anterior vaginal wall prolapse. J Reprod Med 50(2):75–80

    PubMed  Google Scholar 

  11. Eglin G, Ska JM, Serres X (2003) Trans-obturator subvesical mesh. Tolerance and short-term results of 103 case continuous series. Gynecol Obstet Fertil 31:14–19

    Article  PubMed  CAS  Google Scholar 

  12. de Tayrac R, Picone O, Chauveaud-Lambling A, Fernandez H (2006) Two-year anatomical and functional assessment of transvaginal rectocele repair using a polypropylene mesh. Int Urogynecol J 17(2):100–105

    Article  Google Scholar 

  13. Petros PE (2001) Vault Prolapse II: restoration of dynamic vaginal supports by infracoccygeal sacropexy, an axial day-case vaginal procedure. Int Urogynecol J Pelvic Floor Dysfunct 12:296–303

    Article  PubMed  CAS  Google Scholar 

  14. Moore RD, Beyer RD, Jacoby K, Freedman SJ, Mc Cammon KA, Gambla MT (2010) Prospective multicenter trial assessing type I, polypropylene mesh placed via transobturator route for the treatment of anterior vaginal prolapse with 2-year follow-up. Int Urogynecol J Pelvic Floor Dysfunct 21(5):545–552

    Article  Google Scholar 

  15. Nieminen K, Hiltunen R, Takala T, Heiskanen E, Merikari M, Niemi K, Heinonen PK (2010) Outcomes after anterior vaginal wall repair with mesh: a randomized, controlled trial with a 3 year follow-up. Am J Obstet Gynecol 203(3):235.e1–235.e8

    Article  Google Scholar 

  16. Sentilhes L, Berthier A, Sergent F, Verspyck E, Descamps P, Marpeau L (2008) Sexual function in women before and after transvaginal mesh placement for pelvic organ prolapse. Int Urogynecol J 19:763–772

    Article  Google Scholar 

  17. Dwyer PL, O’Reilly BA (2004) Transvaginal repair of anterior and posterior compartment prolapse with atrium polypropylene mesh. Br J Obstet Gynaecol 111:831–836

    Article  Google Scholar 

  18. Milani R, Salvatore S, Soligo M, Pifarotti P, Meschia M, Cortese M (2005) Functional and anatomical outcome of anterior and posterior vaginal prolapse repair with prolene mesh. BJOG 112(1):107–111

    Article  PubMed  Google Scholar 

  19. Carey M, Slack M, Higgs P, Wynn-Williams M, Cornish A (2008) Vaginal surgery for pelvic organ prolapse using mesh and a vaginal support device. BJOG 115:391–397

    Article  PubMed  CAS  Google Scholar 

  20. Zargar MA, Emami M, Zargar K, Jamshidi M (2004) The results of grade IV cystocele repair using mesh. Urol J 1(4):263–267

    PubMed  CAS  Google Scholar 

  21. de Tayrac R, Deffieux X, Gervaise A, Chauveaud-Lambling A, Fernandez H (2006) Long-term anatomical and functional assessment of trans-vaginal cystocele repair using a tension-free polypropylene mesh. Int Urogynecol J 17:483–488

    Article  Google Scholar 

  22. Cervigni M, Natale F, La Penna C, Panei M, Mako A (2008) Transvaginal cystocele repair with polypropylene mesh using a tension-free technique. Int Urogynecol J 19:489–496

    Article  CAS  Google Scholar 

  23. Milani AL, Heidema WM, van der Vloedt WS, Kluivers KB, Withagen MI, Vierhout ME (2008) Vaginal prolapse repair surgery augmented by ultralightweight titanium-coated polypropylene mesh. Eur J Obstet Gynecol Reprod Biol 138(2):232–238

    Article  PubMed  CAS  Google Scholar 

  24. Fatton B, Amblard J, Debodinance P, Cosson M, Jacquetin B (2007) Transvaginal repair of genital prolapse: preliminary results of a new tension-free vaginal mesh (prolift technique): a case series multicentric study. Int Urogynecol J 18:743–752

    Article  CAS  Google Scholar 

  25. Altman D, Väyrynen T, Engh ME, Axelsen S, Falconer C, for the Nordic Transvaginal Mesh Group (2007) Short-term outcome after transvaginal mesh repair of pelvic organ prolapse. Int Urogynecol J 19:787–793

    Article  Google Scholar 

  26. Gauruder-Burmester A, Koutouzidou P, Rohne J, Gronewold M, Tunn R (2007) Follow-up after polypropylene mesh repair of anterior and posterior compartments in patients with recurrent prolapse. Int Urogynecol J 18:1059–1064

    Article  CAS  Google Scholar 

  27. Abdel-Fattah M, Ramsay I, West of Scotland Study Group (2008) Retrospective multicentre study of the new minimally invasive mesh repair devices for pelvic organ prolapse. BJOG 115:22–30

    PubMed  CAS  Google Scholar 

  28. Bai SW, Jung HJ, Jeon MJ, Chung DJ, Kim SK, Kim JW (2007) Surgical repair of anterior wall vaginal defects. Int J Gynaecol Obstet 98:147–150

    Article  PubMed  CAS  Google Scholar 

  29. Amrute KV, Eisenberg ER, Rastinehad AR, Kushner L, Badlani GH (2007) Analysis of outcomes of single polypropylene mesh in total pelvic floor reconstruction. Neurourol Urodyn 26:53–58

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank all the other investigators of the French Ugytex Study Group for their participation to the study: Jean-Louis Bénifla and Fabien Demaria (Rothschild Hospital, Paris), Jérome Blanchot and Pierre-Louis Broux (La Sagesse Private Hospital, Rennes), Michel Cosson and Jean-Philippe Lucot (Jeanne De Flandre University Hospital, Lille), Patrick Delporte (Public Hospital, Dunkerque), Hervé Fernandez (Antoine Béclere University Hospital, Clamart), Christine Frayret (Public Hospital, Chartres), François Hacquin (Santa Maria Private Hospital, Nice), Kazeem-Marc Maaliki (Franche Comté Private Hospital, Besançon), Loïc Marpeau and Fabrice Sergent (University Hospital, Rouen), and Olivier Guilbaud (Public Hospital, Chartres, France).

Funding

This study was funded by Sofradim-Covidien.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Bocage University Hospital, Dijon, France

    Pascal Mourtialon

  2. Department of Obstetrics and Gynaecology, Carémeau University Hospital, Nîmes, France

    Vincent Letouzey & Renaud de Tayrac

  3. Department of Obstetrics and Gynaecology, Champeau Private Hospital, Béziers, France

    Georges Eglin

  4. Service de Gynecologie–Obstétrique Médecine Foetale et Médecine de la Reproduction Humaine, Centre Hospitalier Universitaire, Rue du Professeur Marion, BP 77908, 21079, Dijon CEDEX, France

    Pascal Mourtialon

Authors
  1. Pascal Mourtialon
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  2. Vincent Letouzey
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  3. Georges Eglin
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  4. Renaud de Tayrac
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Consortia

the French Ugytex Study Group

Corresponding author

Correspondence to Pascal Mourtialon.

Additional information

For the list of investigators comprising the French Ugytex Study Group, please refer to Acknowledgments.

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Mourtialon, P., Letouzey, V., Eglin, G. et al. Cystocele repair by vaginal route: comparison of three different surgical techniques of mesh placement. Int Urogynecol J 23, 699–706 (2012). https://doi.org/10.1007/s00192-011-1650-6

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  • DOI: https://doi.org/10.1007/s00192-011-1650-6

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