The use of prosthetics in pelvic reconstructive surgery

Anterior compartment prolapse repair with a hybrid biosynthetic mesh implant technique

The aim of the present study is to assess the safety and feasibility of a new technique for cystocele repair using a hybrid biosynthetic graft fixed by the transobturator approach. This is a retrospective study of 13 women diagnosed with symptomatic anterior compartment prolapse that were in stages II and IV, using Pelvic Organ Prolapse Quantification score and treated between 2003 and 2006. The surgical procedure was carried out through a vaginal approach, exposing the arcus tendineus and the posterior surface of the obturator foramen from the ischial spine to the inferior pubic ramus bone. The patients were followed-up after 3, 6 and 12 months. The anatomical cure rate was 85% (stage 0), although two patients had a recurrence 8 months after surgery. All patients would repeat the procedure, if necessary. No de novo dyspareunia was observed in these small series. The results suggest that this technique is safe and feasible and is a comprehensive surgical approach for anterior compartment prolapse, without postoperative morbidity.

Dyspareunia and chronic pelvic pain after polypropylene mesh augmentation for transvaginal repair of anterior vaginal wall prolapse

Synthetic mesh augmentations for pelvic floor reconstructive surgeries are increasing in usage and popularity. Many studies are focusing on the anatomical success rates of transvaginal anterior compartment repairs with synthetic mesh, with minimal attention on its postoperative complications. We present a case report on a 59-year-old postmenopausal woman who underwent an anterior repair with 6x4-cm polypropylene mesh. Postoperatively, she developed severe dyspareunia and debilitating chronic pelvic pain. The patient failed conservative medical therapy and now requests complete removal of the synthetic mesh.

The use of graft materials in vaginal pelvic floor surgery

OBJECTIVE

To review recent literature on graft materials used in vaginal pelvic floor surgery.

METHODS

A Pubmed-search ("anterior vaginal wall" or "cystocele"), ("posterior vaginal wall" or "rectocele") and ("vaginal vault" or "pelvic prolapse") and ("mesh" or "erosion" or "graft" or "synthetic") from 1995 to 2005 was performed; recent reviews [Birch C. The use of prosthetics in pelvic reconstructive surgery. Best Pract Res Clin Obstet Gynaecol 2005;19:979-91 [1]; Maher C, Baessler K. Surgical management of anterior vaginal wall prolapse: an evidence-based literature review. Int Urogynecol J Pelvic Floor Dysfunct 2005 (May 25) [Electronic Publication] [2]; Maher C, Baessler K. Surgical management of posterior vaginal wall prolapse: an evidence-based literature review. Int Urogynecol J Pelvic Floor Dysfunct 2006;17:84-8 [3]; Altman D, Mellgren A, Zetterstrom J. Rectocele repair using biomaterial augmentation: current documentation and clinical experience. Obstet Gynecol Surv 2005;60:753-60 [4] were added.

RESULT

There are few prospective randomized trials that prove the benefit of implanting grafts in vaginal pelvic floor surgery. Many articles are retrospective case series with small sample sizes or incomplete outcome variables. Serious complications such as erosions are often not mentioned. Inconsistent or unclear criteria for anatomic cure make it difficult to compare outcomes. Quality of life issues such as dyspareunia, urinary or bowel symptoms are often ignored.

CONCLUSION

Due to a lack of well-designed prospective randomized trials, recommendations for using graft materials in vaginal reconstructive surgery cannot be made. At this time, grafts should have limited use in a carefully selected patient population.