Abstract

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.
Lingua originaleEnglish
Numero di pagine0
Stato di pubblicazionePublished - 2003

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