TENSION FREE CYSTOCELE REPAIR. FOUR YEARS FOLLOW-UP

Aims of study: Anterior vaginal wall descensus is one of the mostfrequent alteration in patients with pelvic defects. At least 50% ofwomen that had delivered two or more times presented a certaindegree of this pathologic alteration of the anatomy, even thoughtonly 10-20% of the patients complained of associated pains. Theuse of synthetic biocompatible materials has become more commonin gynecology surgery(1)-(3). Polypropylene mesh to beproposed as a mean of surgical correction of moderate severecystocele (Cervigni 1998)(2)Methods: 97 patients aged 42-75, parity 1-5, body weight 45-90,menopause 41 pts. (61%).Irritative sintoms( nocturia, frequency,urgency, dysuria and urge incontinence, were present in differentpercentage). All the patients underwent a complete urogynecologicalwork up:Physical examination: Vaginal profile, Q-tip test, pad test;Instrumental evaluation: Urodynamic investigation, endoscopy,x-ray.Cistocele of grade II (according to HWS classification) in 27pts. (28%) associated with type 1 and 2 SUI; grade III in 33 pts(34%); grade IV in 37 pts (38%). Rectocele>of grade II in 78 pts(80.4%). Menopausal patients were treated by local or systemicestrogen therapy. We performed vaginal hysterectomy in 56 pts.(57.7%), levator miorraphy in 78 pts. (80.4%), IVS in 9 pts. (9.3%)and TVT in 18 pts. (18.55%). After anterior colpotomy a preshapedpolypropylene (Incontinence mesh angiologica BM) in twodifferent dimension in relation to the size of the cystocele wasplaced up on the perivescical fascia proximal to the bladder neckwithout anchorage stitches.Results: No intraoperative complications occurred. All patientsunderwent objective follow-up (pelvic examination, Q-tip test) andinstrumental evaluation (cystography, urodinamic investigationendoscopy) after 6, 12, 24, 48 months. 24 patients (88.9%) werecontinent, 2 (7.4%) improved and 1 (3.7%) failed.We obtained, after 48 mos, erosion in 7 (7.2%)pts, migrationin 4 (4.1%), dyspareunia in 8 (8.2%)pts, recurrent cystocele in8(8,2%) pts.Conclusions: The use of polypropylene mesh in urogynecologysurgery is an interesting approach of recurrent cystocele afterprevious surgery and in patients with meiopragic perivescical fasciawith moderate severe cystocele.