[Transvaginal treatment of anterior vaginal prolapse with collagen implant transobturator fixation]

Naoufel Miaadi, Karim Ferhi, Gérôme Descargue, Philippe Grise
Progrès en Urologie 2005, 15 (6): 1110-3

INTRODUCTION: Prolapse is a common disease with a multifactorial aetiology that may be either isolated or associated with other pelviperineal defects. Surgical reconstruction of the infravesical anterior segment by isolated colpomyorraphy of prolapse is often disappointing with a recurrence rate of 40% according to the literature. Several procedures, consisting of strengthening of the anterior vaginal wall have been proposed. The use of prosthetic material has revolutionized the treatment of cystocele with a reduction of the recurrence rate but at the price of a poorly defined morbidity. Few published studies have assessed the use of xenogeneic tissue in the treatment of anterior vaginal prolapse. The objective of this study was to demonstrate the feasibility, morbidity and short-term results of the use of Pelvicol reticulated collagen mesh in the treatment of cystoceles.

OBJECTIVE: To demonstrate the feasibility and short-term results of the transvaginal treatment of cystoceles using collagen implant transobturator (TO) fixation. Many new prosthesis-based techniques are designed to decrease recurrences after repair without prosthesis, but they are often non-standardized, with inadequate evaluation and insufficient follow-up. In contrast with synthetic material, few published studies have investigated the use of xenogeneic tissue.

PATIENTS AND METHODS: Twenty-eight patients with a mean age of 70.6 years (range: 53-84) with grade 2 and 3 cystocele and a history of transvaginal prolapse repair in 7 cases, were operated by 2 operators according to an identical technique: the bladder was dissected via a transvaginal approach and a 4 x 7 cm porcine dermis collagen prosthesis was then placed underneath the bladder and fixed, at its anterolateral angles via a TO approach to the midline suburethral part by a resorbable suture. Vaginal hysterectomy was associated in 11 cases.

RESULTS: The mean specific prosthesis insertion time was 25 minutes. No intraoperative complication and no serious bleeding were reported. The mean hospital stay was 3.6 days (range: 2-9). The mean follow-up was 8 months (range: 6-16). One case of mesh expulsion was observed on D15, followed by complete healing without recurrence of the cystocele. One case of slight pain of the medial aspect of the thigh was observed with a favourable secondary outcome. The postoperative anatomical results showed complete repair of the prolapse at 1 month and on review. Two cases of de novo SUI were treated by transobturator suburethral tape with a good postoperative result.

CONCLUSION: The technique is feasible, simple, safe and ensures very satisfactory short-term results. Follow-up of these patients will be continued.

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