Abstract
Study Objective. The objective of this study was to report on the safety and efficacy of cystocele repair with anterior wall mesh placed via a transobturator route (Perigee system, AMS, Minnetonka, MN). Design. Single center retrospective study. Setting. Single center hospital setting and Urogynecology practice in the United States. Patients. 77 women presenting with symptomatic anterior wall prolapse. Intervention. Repair of cystocele with an anterior wall Type I soft-polypropylene mesh placed via a transobturator approach. Concomitant procedures in other compartment were also completed as indicated. Measurements and Main Results. 77 women underwent the Perigee procedure at our institution over a 2-year period. The mesh was attached to the pelvic sidewalls at the level of the bladder neck and near the ischial spine apically with needles passed through the groins and obturator space. Mean follow-up was 18.2 months (range 3–36 months). Objective cure rate was 93%. Subjectively only two patients have had recurrent symptoms of prolapse, and only 1 of these has required repeat surgery for cystocele. Mesh exposure vaginally occurred in 5 patients (6.5%); however all were treated with estrogen and/or local excision of exposed mesh and had no further sequelae. There were no incidences of chronic pain, infection, or abscess, and no patient required complete mesh removal for infection, pain, or extrusion. Conclusion. In select patients with anterior wall prolapse, repair with mesh augmentation via the transobturator route is a safe and effective procedure with up to 3 years of follow-up.
Highlights
Pelvic organ prolapse (POP) is a significant health issue in females worldwide [1, 2]
With the success of apical graft use, more recently, graft augmentation of prolapse repair has been utilized via the vaginal route
Julian first reported on the use of synthetic mesh for cystocele repair in 1996 [5], and Advances in Urology more recently there have been multiple reports of various methods to place grafts via a vaginal approach for cystocele repair [6,7,8,9,10,11,12,13,14,15,16,17,18,19]
Summary
Pelvic organ prolapse (POP) is a significant health issue in females worldwide [1, 2]. Abdominal Y-mesh sacralcolpopexy has the highest cure rates in literature for vault prolapsed, and the benefit of utilizing mesh in the repair seems to outweigh the risks [4] It results in anatomic repair with minimal tension and does not rely on the patients weakened tissue to maintain support. Many different techniques have been reported on various means to attach the graft in place, as this has been proven to be somewhat difficult in the anterior compartment. This lack of standardization as well as the more complex nature of these repairs has resulted in slow acceptance of these techniques to utilize a graft in cystocele repair
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