Minimally invasive cystocele repair technique using a polypropylene mesh introduced with the transobturator route.

Abstract

Evaluation of the safety and efficacy of the use of polypropylene mesh for cystocele repair using minimally invasive technique. We retrospectively evaluated the perioperative events, short-term postoperative side-effects, and follow up for 152 patients who underwent repair for cystocele grade 2 or more using a polypropylene mesh. The repair was performed through a small anterior vaginal wall incision, with the arms of the mesh passed through a transobturator route using a corkscrew needle. Stress urinary incontinence (SUI) tests and the International Continence Society Pelvic Organ Prolapse Quantification (POP-Q) staging systems were documented before and after surgery. The average time and blood loss for the procedure were 18 min and 100 cc, respectively. Bladder injury and excess bleeding (>500 cc) occurred in one and two cases during the procedure, respectively. The early postoperative complications included pain (10.5 %), mesh erosion (1.3 %), fever (1.3 %), and urinary tract infection (7.9 %). Among the 122 patients who were followed up (median follow-up time, 18.2 months), the subjective and objective cure rates for the prolapse were 98 and 95 %, respectively. Complications during the follow up included mesh erosion (four cases) and persistent dyspareunia (four cases). Cystocele repair with mesh placement through transobturator route can be considered a minimally invasive, promising method for the correction of cystocele and SUI based on the low rate of complications, the high rate of success, and the low incidence of recurrence.