Modified Two-corner Raz Suspension Procedure for Cystocele Repair: A Novel Technique

Abstract

Introduction: Prolapse of anterior vaginal wall is a common problem in both perimenopausal and postmenopausal women. In past 200 years, surgical management of cystocele has undergone many changes from Kelly's plication to mesh reinforcement but none of these procedures proved to be 100% effective. Modified two-corner Raz suspension procedure (MTCRSP) can be used for the treatment of POP-Q (pelvic organ prolapse quantification) stage II to IV anterior vaginal wall prolapse (AVP). Objectives:To assess the effectiveness of modified two-corner Raz suspension procedure (MTCRSP) in long-term success for cystocele repair and its effect on quality of life. Study design:A hospital-based prospective study. Materials and methods:Twelve patients underwent modified two-corner Raz procedure and were followed postoperatively for a period of 1 year at regular intervals. During follow-up, we assessed the degree of prolapse by POP-Q, quality of life, and sexual dysfunction. Results:Preoperatively, 3 out of 12 (25%) patients had stage II, five had (41.66%) stage III, and four (33.33%) had stage IV prolapse. Postoperatively, at 1 month follow-up, one (8.33%) patient developed stage II anterior wall prolapse, which progressed to stage IV prolapse at 3 months. Two more patients developed stage II prolapse at 3-month follow-up. Failure rate at the end of 1 year was 25% (3/12). Prolapse quality of life (PQOL) improved in 10 out of 12 (83.33%) patients. While PGII (patient global impression of improvement) score improved in 11 out of 12 (91.66%) women. Conclusion:Modified two-corner Raz suspension procedure is an effective technique with long-term success in stage II and III prolapse but a limited success in stage IV AVP.