Utrasonographic Scan Evaluation of Synthetic Mesh Used for Vaginal Cystocele Repair Comparing Four Arms Trans Obturator Techniques to Anterior Bilateral Sacro Spinous Ligament and Arcus Tendinous Suspension

Abstract

Study Objective: The main objective is the evaluation by Ultrasonographic scan of mesh contraction after vaginal cystocele repair and surgical procedure impact.Design: Between January and September 2009, we included -prospectively 60 patients.Setting: University Hospital.Patients: Sixty patients with vaginal synthetic mesh repair for symptomatic cystocele.Intervention: 30 with trans obturator polypropylene mesh Ugytex™ (Sofradim™, CONVIDIEN™) (TO), and 30 with Pinnacle™ (Boston Scientific™) (SE) mesh for vaginal cystocele repair.We noticed a statistically significant difference between TO mesh contraction and SE mesh contraction in the mid-sagittal length 13% (+/-1.7) vs 4.5% (+/-.8) (p<.05); and for the vaginal vault width 22% (+/-2) TO vs 4% (+/-1.3) SE at W6 (p<.05). At W6, SE mesh was longer than TO of 11mm (+/-5 mm). Mid sagittal arc of TO meshes decreased of 13% (+/- 1.6) between D3 and W6 versus 1% (+/-.2) for SE meshes. Considering the arc of the mesh at W6 and mesh length PO, 50% of the PO length was in place under the vagina at W6 for TO meshes, 60% for TO associated with Richter procedure and 38% for SE.Conclusion: Prospective ultrasonographic scan permits to follow contraction and mesh placement. Anterior bilateral sacro spinous ligament and arcus tendinous suspension for vaginal cystocele mesh seems to have better spreading and less contraction than TO mesh. Study Objective: The main objective is the evaluation by Ultrasonographic scan of mesh contraction after vaginal cystocele repair and surgical procedure impact. Design: Between January and September 2009, we included -prospectively 60 patients. Setting: University Hospital. Patients: Sixty patients with vaginal synthetic mesh repair for symptomatic cystocele. Intervention: 30 with trans obturator polypropylene mesh Ugytex™ (Sofradim™, CONVIDIEN™) (TO), and 30 with Pinnacle™ (Boston Scientific™) (SE) mesh for vaginal cystocele repair. We noticed a statistically significant difference between TO mesh contraction and SE mesh contraction in the mid-sagittal length 13% (+/-1.7) vs 4.5% (+/-.8) (p<.05); and for the vaginal vault width 22% (+/-2) TO vs 4% (+/-1.3) SE at W6 (p<.05). At W6, SE mesh was longer than TO of 11mm (+/-5 mm). Mid sagittal arc of TO meshes decreased of 13% (+/- 1.6) between D3 and W6 versus 1% (+/-.2) for SE meshes. Considering the arc of the mesh at W6 and mesh length PO, 50% of the PO length was in place under the vagina at W6 for TO meshes, 60% for TO associated with Richter procedure and 38% for SE. Conclusion: Prospective ultrasonographic scan permits to follow contraction and mesh placement. Anterior bilateral sacro spinous ligament and arcus tendinous suspension for vaginal cystocele mesh seems to have better spreading and less contraction than TO mesh.