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Zangarelli A, Curinier S, Campagne-Loiseau S, Guy L, Mansoor A. [Cystocele repair by a light tension-free vaginal mesh: results after 6 years of follow-up]. Prog Urol 2020; 30:367-373. [PMID: 32234421 DOI: 10.1016/j.purol.2020.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 02/07/2020] [Accepted: 02/11/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The objective of this study was to evaluate the long-term anatomical and functional efficacy, but also the safety of tension-free vaginal mesh in cystocele repair. METHODS This retrospective and monocentric study included 90 women who underwent a prolapse repair between June 2006 and November 2008. A light-weight polypropylene vaginal mesh (22g/m2, Novasilk COLOPLAST®) was used without any fixation. Females were followed at 1 month, 1 year, 3 years and 6 years. Only long-term results are presented in this study. The anatomical result was assessed by the POP-Q classification and the functional results by standardized symptoms (PFDI-20), sexuality (PISQ-12) and quality of life (PFIQ-7) questionnaires. RESULTS 6 years after surgery, the follow-up rate was 74%. Anatomically, the prolapse recurrence rate (Ba≥0) was 17% (n=8). Functionally, the overall patient satisfaction rate was 89%. Quality of life and symptoms scores (4,11±8.45 vs. 17.5±14.4 and 35.8±15.9 vs 94±23.4 respectively) were significantly improved (p<0.001). Concerning the prevalence of the complication, the retraction and exposition rate was 1.7% (n=1) and a re-intervention rate was 6.7% (n=4). The rate of de novo dyspareunia was 1.7% (n=1). CONCLUSION In this short retrospective series of vaginal mesh interposition for cystocele repair, the prevalence of medium-term patient satisfaction was high.
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Affiliation(s)
- A Zangarelli
- Service d'Urologie, CH de Vichy, boulevard Denière, 03200 Vichy, France.
| | - S Curinier
- Service de Gynécologie, CHU Estaing, 1, rue Lucie Aubrac, 63100 Clermont-Ferrand, France
| | - S Campagne-Loiseau
- Service de Gynécologie, CHU Estaing, 1, rue Lucie Aubrac, 63100 Clermont-Ferrand, France
| | - L Guy
- Service d'Urologie, CHU Clermont-Ferrand, 58, rue Montalembert 63000 Clermont-Ferrand, France
| | - A Mansoor
- Service de Gynécologie, CH d'Issoire, 13, rue du Dr Sauvat, 63500 Issoire, France
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Le Teuff I, Labaki M, Fabbro-Peray P, Debodinance P, Jacquetin B, Marty J, Letouzey V, Eglin G, de Tayrac R. Perioperative morbi-mortality after pelvic organ prolapse surgery in a large French national database from gynecologist surgeons. J Gynecol Obstet Hum Reprod 2019; 48:479-487. [PMID: 31078822 DOI: 10.1016/j.jogoh.2019.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/27/2019] [Accepted: 05/07/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess morbidity and mortality following pelvic organ prolapse surgery in France, irrespective of the surgical technique, using a broad national database. MATERIALS AND METHODS This descriptive multicenter retrospective study was conducted using a database populated via an application run by a professional association. RESULTS 286 gynecologists contributed data to the database. Of the 4322 surgeries analyzed, an abdominal approach was used in 975 of cases (22.5%), a vaginal approach in 3277 (75.9%), and a combined approach in 68 (1.6%). After one year, abdominal surgery was associated with higher rates of de novo urinary incontinence, constipation, and intestinal obstruction, whereas vaginal surgery was associated with higher rates of urinary retention, hematoma, de novo chronic pain, and vaginal mesh extrusion. There was no significant difference between the groups in the incidence of severe complications. After one year, vaginal mesh-augmented cystocele repair was associated with higher rates of de novo urinary incontinence, de novo chronic pain, and reoperation than native tissue repair. Mesh repair was also associated with higher rates of severe complications at one year. CONCLUSION After pelvic organ prolapse surgery, the perioperative morbidity and mortality associated with transabdominal and transvaginal approaches are similar. However, transvaginal mesh repair is associated with greater perioperative morbidity than transvaginal native tissue repair.
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Affiliation(s)
- Isabelle Le Teuff
- Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes, France
| | - Majd Labaki
- Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes, France
| | - Pascale Fabbro-Peray
- Department of Biostatistics, Epidemiology, Public Health and Medical Information (BESPIM), Nîmes University Hospital, Nîmes, France
| | | | - Bernard Jacquetin
- Department of Obstetrics and Gynecology, Estaing University Hospital, Clermont-Ferrand, France
| | | | - Vincent Letouzey
- Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes, France
| | - Georges Eglin
- Department of Obstetrics and Gynecology, Clinique Champeau, Beziers, France
| | - Renaud de Tayrac
- Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes, France.
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Quiboeuf E, Nidecker S, Ballanger P, Hocké C. [Vaginal mesh exposure after prolapse surgery. A descriptive study of 43 cases: Epidemiology and therapeutic management]. Prog Urol 2015; 25:1232-40. [PMID: 26321358 DOI: 10.1016/j.purol.2015.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 07/20/2015] [Accepted: 07/20/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the prevalence and time of occurrence of vaginal mesh exposure based on the initial surgical approach of prolaps. To describe their therapeutic management. MATERIAL Descriptive retrospective study of 43 women followed for vaginal mesh exposure diagnosed during a follow-up visit or motivated by symptoms. The initial surgery was performed abdominally (promontofixation) or vaginally. The therapeutic management was carried out by medical and/or surgical (prosthetic resection partial or complete). RESULTS The prevalence of vaginal exposure was 7.3% in case of vaginal initial surgery and 2.8% in case of promontofixation initial (P=0.02). Mesh exposure have appeared earlier in case of vaginal initial surgery compared to promontofixation (14.9 months vs. 45.2 months). After vaginal initial surgery, vaginal mesh exposure appeared to third within 6 months postoperatively (9/29). The success rate of medical treatment was 21.4%. In total, 31% of women initially made vaginally and 64.9% of women initially made abdominally required at least two surgeries to get a cure. CONCLUSION Vaginal mesh exposure may be away from the initial surgery, especially when the first initial surgery was abdominal. The medical treatment of vaginal mesh exposure led to poor results. The overall rate of healing in our experience was good but at the cost of considerable morbidity as a significant proportion of patients required two or more surgical interventions.
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Affiliation(s)
- E Quiboeuf
- Service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor d'Aquitaine, CHU de Bordeaux, université de Bordeaux 2, place Amélie Raba-Léon, 33076 Bordeaux, France.
| | - S Nidecker
- Service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor d'Aquitaine, CHU de Bordeaux, université de Bordeaux 2, place Amélie Raba-Léon, 33076 Bordeaux, France.
| | - P Ballanger
- Service d'urologie, CHU de Bordeaux, université de Bordeaux 2, place Amélie Raba-Léon, 33076 Bordeaux, France.
| | - C Hocké
- Service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor d'Aquitaine, CHU de Bordeaux, université de Bordeaux 2, place Amélie Raba-Léon, 33076 Bordeaux, France.
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Köse O, Sağlam HS, Kumsar Ş, Budak S, Aydemir H, Adsan Ö. Early results of a novel technique for anterior vaginal wall prolapse repair: anterior vaginal wall darn. BMC Urol 2014; 14:51. [PMID: 24973955 PMCID: PMC4105512 DOI: 10.1186/1471-2490-14-51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 06/25/2014] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND The aim of this study was to describe the results of a 1-year patient follow-up after anterior vaginal wall darn, a novel technique for the repair of anterior vaginal wall prolapse. METHODS Fifty-five patients with anterior vaginal wall prolapse underwent anterior vaginal wall darn. The anterior vaginal wall was detached using sharp and blunt dissection via an incision beginning 1 cm proximal to the external meatus and extending to the vaginal apex. The space between the tissues that attach the lateral vaginal walls to the arcus tendineus fasciae pelvis was then darned. Cough Stress Test, Pelvic Organ Prolapse Quantification, seven-item Incontinence Impact Questionnaire, and six-item Urogenital Distress Inventory scores were performed 1-year postoperatively to evaluate recovery. RESULTS One-year postoperatively, all patients were satisfied with the results of the procedure. No patient had vaginal mucosal erosion or any other complication. CONCLUSIONS One-year postoperative findings for patients in this series indicate that patients with stage II-III anterior vaginal wall prolapse were successfully treated with the anterior vaginal wall darn technique.
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Affiliation(s)
- Osman Köse
- Department of Urology, Faculty of Medicine, Sakarya University and Training and Research Hospital, 54100 Sakarya, Turkey
- Beyaz Kent Sitesi, Beşköprü M. Girne C., 54100 Sakarya, Turkey
| | - Hasan S Sağlam
- Department of Urology, Faculty of Medicine, Sakarya University and Training and Research Hospital, 54100 Sakarya, Turkey
| | - Şükrü Kumsar
- Department of Urology, Faculty of Medicine, Sakarya University and Training and Research Hospital, 54100 Sakarya, Turkey
| | - Salih Budak
- Department of Urology, Faculty of Medicine, Sakarya University and Training and Research Hospital, 54100 Sakarya, Turkey
| | - Hüseyin Aydemir
- Department of Urology, Faculty of Medicine, Sakarya University and Training and Research Hospital, 54100 Sakarya, Turkey
| | - Öztuğ Adsan
- Department of Urology, Faculty of Medicine, Sakarya University and Training and Research Hospital, 54100 Sakarya, Turkey
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[PROSPERE randomized controlled trial: laparoscopic sacropexy versus vaginal mesh for cystocele POP repair]. ACTA ACUST UNITED AC 2013; 42:334-41. [PMID: 23618743 DOI: 10.1016/j.jgyn.2013.03.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 03/13/2013] [Accepted: 03/14/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cystocele is a frequent and invalidating type of genital prolapse in woman. Sacropexy using synthetic mesh is considered the surgical gold standard, and the laparoscopic approach has supplanted the open abdominal route because it offers the same anatomical results with a lower morbidity. The use of mesh through the vaginal route may have many advantages: easiness to perform, shorter operative time and recovery, but may increase morbidity. In France, both laparoscopic sacropexy and vaginal mesh are commonly used to treat cystoceles. The French Haute Autorité de santé (HAS) has highlighted the lack of evaluation of safety assessment for vaginal meshes. METHOD/DESIGN The main objective of the study is to compare the morbidity of laparoscopic sacropexy with vaginal mesh for cystocele repair. The primary endpoint will be the rate of surgical complications greater or equal to grade 2 of the Clavien-Dindo classification at 1-year follow-up. The secondary aims are to compare the functional results in the medium term (sexuality, urinary and bowel symptoms, pain), the impact on quality of life as well as anatomical results. PROSPERE is a randomized controlled trial conducted in 12 participating French hospitals. 262 patients, aged 45 to 75years old, with cystocele greater or equal to stage 2 of the POP-Q classification (isolated or not) will be included. Exclusion criterias are a previous surgical POP repair, and inability or contra-indication to one or the other technique. We have designed this study to answer the question of the choice between laparoscopic sacropexy and vaginal mesh for the treatment of cystocele. The PROSPERE trial aims to help better determine the indications for one or the other of these techniques, which are currently based on subjective choices or school attitudes. This is the reason why competent authorities have asked for such studies.
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A novel technique for anterior vaginal wall prolapse repair: anterior vaginal wall darn. ScientificWorldJournal 2013; 2013:198542. [PMID: 23476121 PMCID: PMC3583140 DOI: 10.1155/2013/198542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Accepted: 01/17/2013] [Indexed: 11/17/2022] Open
Abstract
AIM The aim of this study is to introduce a new technique, anterior vaginal wall darn (AVWD), which has not been used before to repair the anterior vaginal wall prolapse, a common problem among women. MATERIALS AND METHODS Forty-five women suffering from anterior vaginal wall prolapse were operated on with a new technique. The anterior vaginal wall was detached by sharp and blunt dissection via an incision beginning from the 1 cm proximal aspect of the external meatus extending to the vaginal apex, and the space between the tissues that attach the lateral walls of the vagina to the arcus tendineus fascia pelvis (ATFP) was then darned. Preoperation and early postoperation evaluations of the patients were conducted and summarized. RESULTS Data were collected six months after operation. Cough stress test (CST), Pelvic Organ Prolapse Quantification (POP-Q) evaluation, Incontinence Impact Questionnaire (IIQ-7), and Urogenital Distress Inventory (UDI-6) scores indicated recovery. According to the early postoperation results, all patients were satisfied with the operation. No vaginal mucosal erosion or any other complications were detected. CONCLUSION In this initial series, our short-term results suggested that patients with grade II-III anterior vaginal wall prolapsus might be treated successfully with the AVWD method.
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Lucot JP, Bot-Robin V, Giraudet G, Rubod C, Boulanger L, Dedet B, Vinatier D, Collinet P, Cosson M. Place du matériel prothétique dans le traitement du prolapsus par voie vaginale. ACTA ACUST UNITED AC 2011; 39:232-44. [DOI: 10.1016/j.gyobfe.2011.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 02/11/2011] [Indexed: 11/30/2022]
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von Theobald P. Place of mesh in vaginal surgery, including its removal and revision. Best Pract Res Clin Obstet Gynaecol 2011; 25:197-203. [DOI: 10.1016/j.bpobgyn.2010.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 11/11/2010] [Indexed: 12/26/2022]
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Jacquetin B. [Toward the acceptance of using vaginal prosthetic reinforcement implants: a new step?]. J Gynecol Obstet Hum Reprod 2010; 39:517-519. [PMID: 20943329 DOI: 10.1016/j.jgyn.2010.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2010] [Indexed: 05/30/2023]
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Mourtialon P, Delorme E, Douvier S, Mares P, Sagot P, de Tayrac R. Proposition d’une classification des techniques chirurgicales de cure de prolapsus (pelvic organ prolapse-surgical technique [POP-ST]) avec mise en place d’une prothèse par voie transvaginale. ACTA ACUST UNITED AC 2010; 39:537-48. [DOI: 10.1016/j.jgyn.2010.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 06/07/2010] [Accepted: 06/14/2010] [Indexed: 11/30/2022]
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Ouaïssi M, Cresti S, Giger U, Sielezneff I, Pirrò N, Berthet B, Grandval P, Consentino B, Sastre B. Management of recto-vaginal fistulas after prosthetic reinforcement treatment for pelvic organ prolapse. World J Gastroenterol 2010; 16:3011-5. [PMID: 20572304 PMCID: PMC2890941 DOI: 10.3748/wjg.v16.i24.3011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To communicate our findings on successful treatment of recto-vaginal fistulas (RVFs) after prosthetic reinforcement surgery of pelvic organ prolapse (POP).
METHODS: A retrospective single center study between 1998 and 2008 was performed. A total of 80 patients with RVF were identified, of which five patients (6%), with a mean age of 65 years (range: 52-73), had undergone previous surgery for POP with prosthetic reinforcement.
RESULTS: All patients complained about ongoing vaginal infections and febrile episodes. These symptoms were reported after a mean period of 18 mo after POP repair. As a first intervention, three patients underwent ablation of the prosthetic material (PM). As a second intervention, open proctectomy with a primary anastomosis, an omental patch, and a protective ileostomy were performed in two patients. One patient required a terminal colostomy due to complete destruction of the anal sphincters. In two other patients, ablation of the PM and proctectomy was performed as a one-step procedure. The postoperative course in all patients was uneventful, with a mean length of hospitalization of 20 d (range: 15-30). Closure of the ileostomy was achieved in all four patients within four months. After a mean period of 35 mo (range: 4-60) of follow-up, no recurrence was observed with normal continence in four patients.
CONCLUSION: In our experience, the definitive treatment of high RVFs after PM repair for POP necessitates ablation of the PM, proctectomy with a primary colo-rectal anastomosis, an omental patch interposition, and a temporary ileostomy.
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Letouzey V, Fritel X, Pierre F, Courtieu C, Marès P, de Tayrac R. [Informing a patient about surgical treatment for pelvic organ prolapse]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2010; 38:255-260. [PMID: 20362480 DOI: 10.1016/j.gyobfe.2010.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 02/13/2010] [Indexed: 05/29/2023]
Abstract
Inform consent is a major objective in the relation patient-physician. Patient's information becomes doubt when it is insufficient. To answer to medical persons asking about patient's information, pretreatment clinical and paraclinical assessment will be discussed. Reflexion delay, surgical alternative therapy and pre-operatory examination will be exposed. Several critical situations, such as associated hysterectomy, patient's comorbidity (tobacco, obesity) or synthetic mesh reinforcement have to be well-known to inform patient about failures and outcomes.
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Affiliation(s)
- V Letouzey
- Service de gynécologie-obstétrique, hôpital Carémeau, CHU de Nîmes, Nîmes, France.
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Trichot C, Salet-Lizee D, Herry M, Bader G, Ansquer Y, Freiderich L, Dhainaut C, Fauconnier A, Chapron C, Panel P, Darai E, Villet R, Fernandez H, Deffieux X. Création d’un registre des complications du traitement chirurgical des prolapsus génitaux. ACTA ACUST UNITED AC 2010. [DOI: 10.1007/s11608-010-0288-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cortesse A, Haab F, Costa P, Delmas V. [Cure of rectocele by vaginal way]. Prog Urol 2009; 19:1080-5. [PMID: 19969279 DOI: 10.1016/j.purol.2009.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 10/26/2009] [Indexed: 12/22/2022]
Abstract
Rectocele is a rectal hernia through the posterior vaginal wall. There is three levels of rectocele. High rectocele is caused by the uterosacral and cardinal ligaments stretching; it needs prerecti fascia placation with a sacrofixation of an associated prolapsus of uterus or vaginal vault. The middle rectocele is linked with a rectovaginal fascia defect; the preferential choice for middle rectocele is midline fascial plication; superior myoraphy gives dyspareunia. The inferior rectocele results of a destruction of the perineal body; the treatment is a myoraphy with vulvoraphy. Complete rectocele would be an indication for a posterior mesh.
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Affiliation(s)
- A Cortesse
- Service d'Urologie, Hôpital Saint-Louis, AP-HP, 1 Avenue Claude-Vellefaux, 75010 Paris, France.
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Fatton B, Savary D, Amblard J, Jacquetin B. [How to manage multicompartment pelvic organe prolapse?]. Prog Urol 2009; 19:1086-97. [PMID: 19969280 DOI: 10.1016/j.purol.2009.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Accepted: 10/01/2009] [Indexed: 10/20/2022]
Abstract
Repair of pelvic organ prolapse by vaginal route may use native tissues or meshes, which have been in extensive use over the last decades. Traditional surgery, and particularly sacrospinous fixation, has been proven to be effective with long term follow-up with well-known specific risks that could be avoided by skilled surgeons on condition that he observes basic vaginal surgery rules. This surgery is still recommended as first choice in patients over 70 years old with high-grade prolapse. Nevertheless recurrence rate after high-grade cystocele repair using native tissues as been reported between 30 and 50% depending on the technique used. Mesh repair and particularly the use of mesh kits is a valid option in case of prolapse with cystocele behind the hymen, specifically in case of paravaginal defect. Meshes use is licit in patients with prolapse recurrence as well. In contrast, spread use of transvaginal meshes in young patients with grade 3 or 4 prolapse whom tissues have a poor quality, has to be considered very carefully because of the lack of knowledge about long term results and sexual outcome.
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Affiliation(s)
- B Fatton
- Service de Gynécologie-Obstétrique, CHU de Clermont-Ferrand, Université d'Auvergne Clermont-Ferrand 1, 63058 Clermont-Ferrand, France.
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Delmas V, Haab F, Costa P. Cystocèle : place des implants de renforcement par voie vaginale. Prog Urol 2009; 19:1025-30. [DOI: 10.1016/j.purol.2009.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 10/26/2009] [Indexed: 11/26/2022]
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