The use of tantalum mesh in cystocele with critical report of ten cases

Abstract

This is a preliminary report of the use of tatalum mesh gauze to supplement the conventional Kennedy-type plication technique for the correction of cystoceles. In each case, the cystocele was sufficiently large to put the procedure to a real test. The tantalum mesh was not used with the intent of offering immediate support to the repair as a hammocklike sling but to offer eventual support by the additional fibrous tissue which would be formed in and about the mesh.Follow-up examinations over a period of from six to eighteen months in 9 cases revealed no recurrent cystoceles. The only adverse finding attributed to the mesh was the slonghing of areas of the superticial vaginal wall in 4 cases with partial exposure of the mesh. This did not represent a serious problem. The exposed mesh was trimmed in two cases. Granulation tissue progressively is covering the defects in the vaginal wall.We believe the slough occurred because, as in any plastic flap that sloughs, the circulation was not adequately maintained in the vaginal wall overlying the tantalum mesh. Ischemic necrosis imdoubtedly occurred. Care should be taken to reflect the vaginal wall in its complete thickness, rather than split to preserve good vascularity. A variation which we propose to use in the future is the technique of overlapping the vaginal muscularis as described by Bissell23 (Fig. 5).We believe this closure will preserve the vascularity and reduce the possibility of ischemic necrosis.We intend to continue to use tantalum mesh cantiously in the repair of cystoceles and in addition to operate upon a series of patients using lyophilized fascia lata for a study of comparative results.