An alternative approach to the repair of cystoceles and rectoceles

Abstract

Purpose: We present an alternative approach to repair severe or recurrent central anterior wall defects and high posterior wall defects. Background: Pelvic prolapse is one of the most common problems with which a gynecologist deals. One in nine women in the United States suffers from prolapse. Of those who undergo surgery, 25–30% will have a recurrence. It long has been recognized that the patient tissue available for repair often is less than optimal. Implantable material was used as early as 1955 in an attempt to improve the strength and longevity of the repair. Unfortunately, these materials often resulted in infection, sinus formation, or erosion. A better understanding of anatomy has improved our ability to recognize and repair these defects, especially paravaginal defects in the anterior compartment and site-specific defects in the posterior compartment. However, severe or recurrent central anterior defects and high posterior (Level I) defects have little or no supportive tissue to use in the repair. Results and Conclusions: Fifty women have undergone this alternative procedure to repair cystocele and rectocele from January through October 2000, using donor collagen. The use of donor collagen in the repair of these defects has resulted in no infections or erosions, and there has been no evidence of recurrence during our initial follow-up.