Cystocele Repair by a Modified Surgical Technique of Bilateral Pubococcygeus Plication: Long-Term Surgical and Functional Results.

Matteo Balzarro,Alessandro Antonelli,Emanuele Rubilotta

doi:10.3390/jcm9103318

Matteo Balzarro, Alessandro Antonelli + Show 1 more

Open Access

https://doi.org/10.3390/jcm9103318

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Abstract

Here we describe our modified surgical technique of bilateral pubococcygeus plication (BPCP) for cystocele repair and assess its safety and long-term outcomes. This is a prospective study of 147 consecutive women who underwent BPCP for cystocele between January 2010 to January 2018. Inclusion criteria was naïve women with symptomatic cystocele ≥ POP-Q 2nd stage. Exclusion criteria: stress urinary incontinence (SUI), urgency urinary incontinence, other associated vaginal wall prolapses ≥ stage 2, neurological diseases, previous SUI surgeries, and previous radiation/surgery of the pelvic area. BPCP was performed by obtaining the medialization of the pubococcygeus muscle fibers of the right and left sides. Statistical analysis was performed. Objective cure was POP-Q < 2nd stage. Subjective cure and functional outcomes were evaluated by validated questionnaires. Patient’s satisfaction was assessed by a Likert-type scale. Mean operative time was 64 min. At a mean follow-up of 82.4 months, objective and subjective success rates were 89.8% and 92.2% respectively. De novo urgency was 3.2%. Surgery did not alter sexual function. Complications occurred in 4.8%, and were: wrong dissection plane, hematoma, and pain lasting between 24–72 h. BPCP for correction of cystocele is safe and effective, with limited risk of complication and good long-term results.

Highlights

Pelvic organ prolapse (POP) is a common pathological condition affecting millions of women, and its incidence is likely to increase further because of aging populations [1].Concerning the surgical treatment of the anterior compartment, several materials including native tissue, allograft, xenograft, and mesh have been used
Here we describe our modified surgical technique of bilateral pubococcygeus plication (BPCP) for cystocele repair and assess its safety and long-term outcomes
The high rate of mesh complications, and the poor outcomes in the long term with anterior colporrhaphy, lead us to research a stronger native support for anterior vaginal wall repair. We found this native reinforcement in the modified bilateral pubococcygeus plication (BPCP)

Summary

Introduction

Pelvic organ prolapse (POP) is a common pathological condition affecting millions of women, and its incidence is likely to increase further because of aging populations [1]. The large use of trans-vaginal mesh for anterior vaginal wall repair to ensure greater effectiveness and duration of treatment has greatly reduced the use of native tissue surgical techniques. Surgeons who prefer the use of native tissue for anterior vaginal repair researched modified techniques to improve the outcomes. The high rate of mesh complications, and the poor outcomes in the long term with anterior colporrhaphy, lead us to research a stronger native support for anterior vaginal wall repair. We found this native reinforcement in the modified bilateral pubococcygeus plication (BPCP). The aim of this study is to describe and illustrate BPCP, and to report the long-term outcomes in treating patients with cystocele in a tertiary referral setting

Data Acquisition

Surgical Technique

Complications

Discussion

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