OP13.06: Ultrasonographic scan evaluation of synthetic mesh used for vaginal cystocele repair comparing two techniques at 2 years follow up

Abstract

Global failure: Cystocele with high mobility of cranial and caudal mesh aspects on Valsalva. Results: We saw 301 patients ≥3 months after AC + mesh. 5 were excluded because of missing data, leaving 296. Mean follow-up was 1.8 years (0.3–5.6). 139 had a Perigee, 66 an Anterior Prolift, 91 an Anterior Elevate. 242 (82%) were satisfied with the outcome, 275 (93%) considered themselves cured/improved. Recurrent prolapse symptoms were reported in 65 (22%). Recurrent cystocele was noted in 128 (43%) clinically and 105 (35%) on US. Mean Ba was −1.6 (−3 to +2). Mean cystocele descent was 5.1 mm below the pubis (+ 21.8 to −44 mm). Avulsion was diagnosed in 117 patients (39.5%). Mean hiatal area on Valsalva was 33.3 cm2. Mesh failure was diagnosed in 112 (38%); global in 81, apical in 23 and anterior in 8. Cystocele recurrence was associated with hiatal area (P < 0.001) and avulsion (P = 0.017). Apical and global mesh failure were also significantly associated with these parameters, but this was not the case for anterior failure. Conclusions: We documented mesh failure after AC + mesh in 38% at a mean of 1.8 years. Most were global or apical failures, implying dislodgment of lateral and/or apical anchors or fixation, and associated with hiatal area. It is plausible that a larger hiatus subjects anchoring structures to greater loads, increasing recurrence risk. Future studies should focus on improving implant design.