TENSION FREE CYSTOCELE REPAIR. FOUR YEARS FOLLOW-UP

Aims of study: Anterior vaginal wall descensus is one of the most frequent alteration in patients with pelvic defects. At least 50% of women that had delivered two or more times presented a certain degree of this pathologic alteration of the anatomy, even thought only 10-20% of the patients complained of associated pains. The use of synthetic biocompatible materials has become more common in gynecology surgery(1)-(3). Polypropylene mesh to be proposed as a mean of surgical correction of moderate severe cystocele (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 different percentage). All the patients underwent a complete urogynecological work 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 27 pts. (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 systemic estrogen 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 preshaped polypropylene (Incontinence mesh angiologica BM) in two different dimension in relation to the size of the cystocele was placed up on the perivescical fascia proximal to the bladder neck without anchorage stitches. Results: No intraoperative complications occurred. All patients underwent objective follow-up (pelvic examination, Q-tip test) and instrumental evaluation (cystography, urodinamic investigation endoscopy) after 6, 12, 24, 48 months. 24 patients (88.9%) were continent, 2 (7.4%) improved and 1 (3.7%) failed. We obtained, after 48 mos, erosion in 7 (7.2%)pts, migration in 4 (4.1%), dyspareunia in 8 (8.2%)pts, recurrent cystocele in 8(8,2%) pts. Conclusions: The use of polypropylene mesh in urogynecology surgery is an interesting approach of recurrent cystocele after previous surgery and in patients with meiopragic perivescical fascia with moderate severe cystocele.