Correction of cystocele and stress incontinence with anterior transobturator mesh.

OBJECTIVE: To evaluate the effectiveness and safety of anterior transobturator mesh for treating cystocele with or without urinary stress incontinence.

STUDY DESIGN: Eighty-five women with cystocele, with or without USI, underwent anterior transobturator vaginal mesh operation. All patients were examined after 4 months. Seventy-two of them were evaluated via questionnaire after 7 months with respect to complications, the effectiveness of the operation and its influence on their quality of life. Women with urinary stress incontinence in addition to cystocele (62.5%) underwent suburethral mesh placement with the anterior mesh-arms used like a transobturator sling.

RESULTS: Recurrence of stage 1 cystoceles were seen in 9.6% of patients but no recurrence of symptomatic cystocele was observed. Mesh erosion of the central anterior vaginal wall appeared in 5.9%. Three revisions but no mesh explantation became necessary. Urinary stress incontinence was cured in 83.3%, while it improved in 9.3%. Urge incontinence was cured in 28.6% of patients and improved in 17.5%. De novo urge incontinence occurred four times and de novo urinary stress incontinence was found in three patients. Among sexually active women, 27% reported improved intercourse, while 24.3% reported a change for the worse. Quality of life improved in 81.9%, and 95.8% would undergo the procedure again.

CONCLUSION: Anterior transobturator mesh is a safe method to treat cystocele with or without stress urinary incontinence and yields good initial results.