Korean J Urol.  2015 Dec;56(12):811-816. 10.4111/kju.2015.56.12.811.

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

• Sharifiaghdas F
• Daneshpajooh A
• Mirzaei M

• KMID: 2359873
• DOI: http://doi.org/10.4111/kju.2015.56.12.811

Abstract

PURPOSE
To 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 METHODS
Between September 2010 and August 2013, a prospective single-center trial was performed to evaluate women with stage> or =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.
RESULTS
A 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.
CONCLUSIONS
The 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.

Keyword

Cystocele; Dyspareunia; Polypropylene; Stress urinary incontinence

MeSH Terms

Aged
Aged, 80 and over
Cystocele/complications/*surgery
Female
Follow-Up Studies
Humans
Middle Aged
Polypropylenes
Postoperative Complications
Prospective Studies
Quality of Life
*Surgical Mesh
Treatment Outcome
Urinary Incontinence, Stress/complications/*surgery
Urinary Tract Infections/etiology
Polypropylenes

Figure

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  Fig. 1 The Nazca-Tc pelvic organ prolapse repair system.

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  Fig. 2 Symptoms at presentation. UTI, urinary tract infection; SUI, stress urinary incontinence.

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