Simultaneous treatment of anterior vaginal wall prolapse and stress urinary incontinence by using transobturator four arms polypropylene mesh

Abstract

PurposeTo evaluate the medium-term efficacy and safety of transobturator four-arm polypropylene mesh in the treatment of high-stage anterior vaginal wall prolapse and concomitant stress urinary incontinence (SUI).Materials and MethodsBetween September 2010 and August 2013, a prospective single-center trial was performed to evaluate women with stage≥3 anterior vaginal wall prolapse with or without SUI who presented to Labbafinejad Hospital, Teheran, Iran, and underwent anterior vaginal wall repair with polypropylene mesh. Pre- and postoperative evaluation included history; physical examination using the Pelvic Organ Prolapse Quantification system and cough stress test, both before and after reduction of prolapsed structures; Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ); urinalysis and culture; and a postvoid residual assessment. Complications were reported at a mean of 2 years of follow-up.ResultsA total of 71 patients underwent cystocele repair with the transobturator four-arm polypropylene mesh. Seven of the patients were lost to follow-up. There were no perioperative complications. The anatomical success rate was 87.5%. The subjective success rate was 92.1%. The PFDI and PFIQ were significantly improved after surgery (p<0.001). Among those with the simultaneous complaint of SUI, 82% were cured without any additional procedure. Three patients (4.6%) experienced vaginal mesh extrusion. Two patients (3.1%) reported worsening of dyspareunia after surgery.ConclusionsThe four arms polypropylene mesh is an effective device for simultaneous correction of anterior vaginal wall prolapse and SUI with a low complication rate at a medium-term follow-up. The majority of the subgroup with concomitant SUI were cured without a second simultaneous procedure.

Transobturator four arms mesh in the surgical management of stress urinary incontinence with cystocele

“…Also, the anatomical success rate in our study was 96%, according to POP classification similar to that found in the study by Yonguc et al [20] which was 96% in medium term follow-up with double sling procedure. This outcome was better than that was found in another study [13] in which anatomical and subjective success rates were 87.5% and 92.1%, respectively.…”

“…Blood transfusions during POP repair were required due to lateral vaginal wall dissection not related to the passage of the needle. [24] Vaginal mesh erosion is one of the most common complications after POP repair whose incidence rtates ranged from 4% to 30% [13,21,22,[25][26][27][28][29] while in the study done by Yonguc et al [20] any mesh erosion had not been observed. In our study, vaginal mesh erosion was observed in one patient (2%) that was improved on local estrogen cream without operative intervention.…”

“…[31,32] At follow-up visits 4 (8%) patients developed dyspareunia that was improved on local estrogen cream which was in accordance with the results of Palma et al [29] who used the Nazca-Tc mesh kit and the rate of dyspareunia in their study was reportedly 2.7%. In a study by Sharifiaghdas et al [13] 68.9% of the patients who were sexually active reported improvement in their sexual function after surgery and only 6.8% of them complained of worsening of dyspareunia, similarly Yonguc et al [20] reported that their 2 patients developed dyspareunia.…”

“…[23] In other studies performed by Moore et al [24] and Yonguc et al [20] one case in each study required blood transfusions. On the other hand, in a study by Sharifiaghdas et al [13] two patients had required one unit of blood postoperatively. Blood transfusions during POP repair were required due to lateral vaginal wall dissection not related to the passage of the needle.…”

“…[8] Double transobturator four arms polypropylene mesh was introduced for the management of SUI beside anterior compartment repair. [13] Complications related to placement of mesh or passage of needle entrance such as visceral or vascular injury, also pelvic pain or mesh extrusion were reported. [14] This study aims to evaluate safety and efficacy of four arms polypropylene mesh in management of SUI associated with cystocele during the long term follow-up.…”