Anterior Vaginal Wall Prolapse Repair Research Articles

Effect of anterior vaginal wall prolapse repair by modified transvaginal mesh surgery: a retrospective cohort study.

To explore clinical outcomes and complications of modified Transvaginal mesh (M-TVM) for advanced anterior vaginal wall prolapse in 1year follow-up. 574 patients underwent TVM surgeries from 2019 to 2020 were collected and divided into TVM group and M-TVM group, all preoperative and postoperative data was obtained and compared between the two groups. 285 women were involved eventually, including 181 in TVM group and 104 in M-TVM group. No significant difference of general conditions was found between these two groups. After long-term follow-up, patients in TVM group were more likely to suffer from pelvic pain than M-TVM group (P = 0.046). Meshes seemed much wider in M-TVM group (4.5 ± 0.69cm) than in TVM group (3.0 ± 0.91cm). No matter TVM or M-TVM, surgeries can significantly change point Aa and Ba when compared to preoperative data. Compared to TVM group, point C and D were significant changed in patients in M-TVM group after surgery (P < 0.001) CONCLUSION: M-TVM is a commendable procedure that can significant correct anterior prolapse with mesh extended wider, and also supply stable apical support at the same time.

Comparative Outcomes of Surgical Treatments for Primary Stress Urinary Incontinence in Women: A Retrospective Cohort Study

Introduction: The study evaluates the outcomes of different surgical techniques, including Tension-free Vaginal Tape (TVT), Trans-Obturator Tape (TOT), Burch Colpopexy (BC), and Anterior Vaginal Wall Prolapse Repair (APR), in treating primary stress urinary incontinence (SUI) in women. Materials and Methods: A retrospective cohort study was conducted in a tertiary care center, comprising 62 women diagnosed with primary SUI who underwent one of the aforementioned surgical procedures. Demographic and clinical variables were analyzed, including age, BMI, menopausal status, reproductive history, incontinence types, anticholinergic use, and preoperative assessments. Results: No differences were found in age (p=0.227), weight (p=0.943), height (p=0.333), and BMI (p=0.642) among the four treatment groups. The distribution of menopausal patients and reproductive history variables did not differ among the groups. Postoperative anticholinergic prescription rates (p=0.769) and duration of use (p=0.531) were not different across the groups. The majority of patients in the TVT, TOT, and BC groups had a grade 2 cystocele (p=0.065). The BC group had 100% grade 1 rectocele, which was not significant compared to other groups (p=0.126). Conclusion: Our results showed no potential difference in comparable outcomes among TVT, TOT, BC, and APR for the surgical treatment of primary SUI.

Current techniques used to perform surgery for anterior and posterior vaginal wall prolapse in South Korea.

ObjectiveThis study aimed to evaluate the current surgical techniques for anterior and posterior vaginal wall prolapse repair in South Korea.MethodsA web-based questionnaire survey was sent to 780 members of the Korean Society of Obstetrics and Gynecology. The items assessed in the questionnaire were the demographic characteristics and current surgical techniques used for the correction of anterior and posterior vaginal wall prolapse.ResultsThe response rate was 16%. There were variations in the suture materials and methods used for anterior and posterior colporrhaphy. Most respondents used only rapid absorbable suture materials to plicate the fibromuscular layer and close the mucosal layer of the anterior and posterior vaginal wall. Simple interrupted sutures are the most popular suture method for both the fibromuscular and mucosal layers. Thirty-one and eleven percent of the respondents used mesh for surgical correction of anterior and posterior vaginal wall prolapse, respectively. Concomitant perineorrhaphy was routinely performed with posterior vaginal wall repair by 42% of the respondents, whereas 58% performed perineorrhaphy only in cases with perineal defects.ConclusionThere is considerable diversity in the current surgical techniques for anterior and posterior vaginal wall prolapse repair in Korea. Further research is required to standardize the surgical techniques.

Transvaginal repair of anterior vaginal wall prolapse with polyvinylidene fluoride (PVDF) mesh: an alternative for previously restricted materials?

To study the mid-term safety and functional outcomes of transvaginal anterior vaginal wall prolapse repair using polyvinylidene fluoride (PVDF) mesh (DynaMesh®-PR4) by the double trans-obturator technique (TOT). Between 2015 and 2020, we prospectively included women with symptomatic high-stage anterior vaginal wall prolapse with or without uterine prolapse or stress urinary incontinence (SUI) in the study. The patients underwent transvaginal repair of the prolapse using PVDF mesh in two medical centers. We followed all patients for at least 12months. We recorded the characteristics of vaginal and sexual symptoms, urinary incontinence, and prolapse stage pre- and postoperatively using International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS), International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF), and Pelvic Organ Prolapse Quantification (POP-Q) system, respectively. One hundred eight women were included in the final analysis with a mean follow-up time of 34.5 ± 18.6months. The anatomical success was achieved in 103 (95.4%) patients. There was a significant improvement in patients' vaginal symptoms, urinary incontinence, and quality of life scores postoperatively (p < 0.0001). Only six patients (5.5%) had mesh extrusion, five of whom were managed successfully. The total rates of complications and de novo urinary symptoms were 21.3% and 7.4%, respectively. Significant pain was reported in 17 cases (15.7%). Our findings show that using PVDF mesh in the double TOT technique for anterior vaginal wall prolapse repair is a safe procedure with high anatomic and functional success rates and acceptable complication rates in mid-term follow-up.

Anterior Vaginal Wall Prolapse Repair and the Rise and Fall of Transvaginal Mesh. Did We Come Full Circle? A Historical Perspective

ObjectiveTo present a brief historical review of treatment options for pelvic organ prolapse with a focus on anterior vaginal wall defects and highlight changing practice patterns in the era of synthetic mesh controversy. MethodsA MEDLINE and PubMed search was performed using the keywords pelvic organ prolapse, anterior colporrhaphy, and cystocele followed by a manual search of bibliographies. ResultsAncient treatments included Hippocratic succession, local astringent, and use of pomegranates as crude pessaries. More sophisticated surgical techniques evolved in the 19th century with further refinement in the early 20th century. Numerous native tissue apposition techniques were popularized by Kelly, Kennedy, Burch, and Raz. Due to poor durability, surgeons sought alternate approaches including biologic and synthetic grafts. Synthetic transvaginal mesh (TVM) initially included use of Tantalum and Marlex to repair anterior wall defects. Both were eventually abandoned due to complications. TVM was re-designed, re-marketed, and re-introduced. Type 1 polypropylene monofilament TVM use became ubiquitous in female pelvic surgery peaking between 2004 and 2008. Initial promising outcomes were soon eclipsed by a surge of adverse events leading to multiple FDA warnings, reclassification to Class III, high-risk medical device, and ultimately a complete recall in 2019. ConclusionThe bidirectional pendulum swing on use of synthetic TVM has been occurring since its introduction 50 years ago. In the current era of mesh controversy, more practitioners are now revisiting previously described native tissue and biologic graft techniques. It appears that history has repeated itself.

Long term subjective cure rate, urinary tract symptoms and dyspareunia following mesh augmented anterior vaginal wall prolapse repair

IntroductionThe aim of this study was to assess patient-centered long term outcomes following anterior vaginal repair with mesh. MethodsIn January 2015, we identified 124 women who underwent anterior pelvic floor repair with mesh between January 2006 and February 2009. Patient records were reviewed and demographic, clinical, intra-operative and post-operative follow-up data retrieved. Telephone interviews were conducted to access information on clinical outcomes. Associations between baseline characteristics and long term symptoms were assessed by multivariable logistic regression models. ResultsSeventy-nine women were reached and consented to participate. Patients were interviewed 79–104 months after surgery. Their mean age at the time of surgery was 62.48 ± 9.53 years; all had stage III cystocele with a mean POP Q point Ba of 5.32 ± 1.47. Twenty-four (30%) had a previous hysterectomy and 26 (33%) had a previous pelvic organ prolapse or stress urinary incontinence operation. At telephone interviews, recurrence of prolapse symptoms was reported by 11 (13.9%) patients, mostly in the posterior compartment. Only 6 needed a corrective procedure. One patient had her mesh removed due to dyspareunia. Eleven (13.9%) reported lower urinary tract symptoms other than prolapse, as follows: stress urinary incontinence (1), overactive bladder (8) and dyspareunia (2). ConclusionLong term rates of recurrent prolapse, dyspareunia and lower urinary tract symptoms were low for patients who underwent anterior vaginal wall mesh augmentation surgery for symptomatic cystoceles.

Monoprótesis de polipropileno para corrección del prolapso vaginal anterior con o sin incontinencia urinaria

Objetivos: Describir la experiencia en el uso de monoprótesis de polipropileno para corrección del prolapso vaginal anterior con o sin incontinencia urinaria. Diseño: Estudio retrospectivo, longitudinal, serie de casos. Lugar: Hospital Nacional Cayetano Heredia. Participantes: Pacientes operadas de prolapso de pared anterior. Intervenciones: Se estudió 44 pacientes operadas de prolapso de pared anterior durante el año 2008. Todas consultaron por sensación de bulto en vagina y 93,2% por pérdida de orina. Según cuantificación de prolapso del órgano pélvico (CPOP), 93,2% correspondió al grado III y IV. Principales medidas de resultados: Cura del prolapso vaginal y de la incontinencia urinaria de esfuerzo. Resultados: A las 44 pacientes se les realizó tratamiento quirúrgico del prolapso vaginal anterior con malla de polipropileno,además de colocación de malla intravaginal posterior, siendo 19 cirugías (43,2%) con preservación uterina y 25 (56,8%) con histerectomía vaginal. Las complicaciones inmediatas fueron 2 casos de hematoma (8%) y 3 infecciones de cúpula vaginal (12%), ambas del grupo con histerectomía vaginal. Hubo cura subjetiva de la pérdida de orina y sensación de bulto en todos los casos evaluados. Conclusiones: El uso de la monoprótesis de polipropileno puede ser seguro, eficaz y de poca morbilidad, para la corrección del prolapso de pared anterior de vagina. Sin embargo, faltan estudios para establecer resultados adecuados a largo plazo.

Trans-vaginal anterior vaginal wall prolapse repair using a customized tension-free bell-shaped prolene mesh: A single-center experience with long-term functional analysis.

Introduction:The existing literature shows that mesh reinforcement improves the anatomical success rate of cystocele repair. We report the long-term results of a custom bell-shaped mesh with simultaneous urethral support for the repair of cystocele.Materials and Methods:The present study was a single-center, single-surgeon case series of 36 patients. Only patients with Pelvic Organ Prolapse Quantification system (POP-Q) stage 2 and above were included in the study. Patients having rectocele or uterine/vault prolapse were excluded. Body of the mesh was used for reinforcement of the cystocele repair and two limbs were left tension free in the retropubic space. Patients were followed 3 monthly for the first year and yearly thereafter. Recurrence was defined as cystocele ≥stage 2 (Aa or Ba 0) any time after the first follow-up.Results:Mean patient age was 58.5 ± 6.2 years. The mean parity was 3.2 ± 1.6. Of 36 patients, 11 (30.5%) of the patients were POPQ stage 2, 15 (41.7%) were stage 3 and 10 (27.7%) were stage 4 cystocele. The mean follow-up period was 53.4 months, with 32 patients reporting for follow-up till date (88.9%). There was no bladder injury, no mesh erosion or infection. No patient required CIC (clean intermittent catheterization) or had stress urinary incontinence post-operatively at 5 years of follow-up.Conclusion:The bell-shaped mesh is a simple, effective and safe procedure in the surgical management of cystocele with excellent long-term outcome.

Trans-vaginal anterior vaginal wall prolapse repair using a customized tension-free bell-shaped prolene mesh: A single-center experience with long-term functional analysis

Trans-vaginal anterior vaginal wall prolapse repair using a customized tension-free bell-shaped prolene mesh: A single-center experience with long-term functional analysis

A randomized controlled trial comparing anatomical and functional outcome between vaginal colposuspension and transvaginal mesh

Our aim was to compare anatomical and functional outcome between vaginal colposuspension and transvaginal mesh. This was a prospective randomized controlled trial in a teaching hospital. Sixty-eight women with stage ≥3 anterior vaginal wall prolapse according to the Pelvic Organ Prolapse Quantification (POP-Q) system were assessed, randomized, and analyzed. Patients were randomized to anterior colporrhaphy with vaginal colposuspension (n = 35) or transvaginal mesh (n = 33). Primary outcome was objective cure rate of the anterior vaginal wall, defined as POP-Q ≤1 at 2years. Secondary outcomes were functional results, quality-of-life (QoL) scores, mesh-related morbidity, and onset of urinary incontinence. The anatomical result for point Ba was significantly better at 2years in the mesh group (-2.8cm) than in the colposuspension group (-2.4cm) (p = 0.02). Concerning POP-Q stages, the anatomical success rate at 2years was 84.4% for colposuspension and 100% for mesh (p = 0.05). There were 5 anatomic recurrences (15.6%) in the colposuspension group. The erosion rate was 6% (n = 2). No significant difference was noted regarding minor complications. Analysis of QoL questionnaires showed overall improvement in both groups, with no significant difference between them. The vaginal colposuspension technique of anterior vaginal wall prolapse repair gave good anatomical and functional results at 2years. Transobturator vaginal mesh gave better 2-year anatomical results than vaginal colposuspension, with overall improvement in QoL in both groups.

A Delayed Type of Ureteric Injury Developed After Transobturator Mesh Procedure for Massive Prolapse

We report on a rare case of delayed presentation of ureteric injury with a transobturator mesh kit for anterior vaginal wall prolapse repair along with conventional vaginal pelvic reconstructive surgery: a case of a 56-year-old multiparous, postmenopausal woman with a body mass index of 22.1 kg/m, who had continuous leakage of urine per vagina 28 days after vaginal hysterectomy, mesh-augmented anterior repair with Avaulta Plus Anterior support system kit (CR Bard Inc, Covington, Ga), and sacrospinous ligament fixation for stage IV pelvic organ prolapse. Pelvic computed tomographic scan with contrast revealed an intact bladder, right hydroureteronephrosis, and right ureterovaginal fistula. Immediate laparotomy performed revealed that the right lower mesh arm was entangled with the distal end of the right ureter, 1.5 cm from the ureteric orifice. Category, time, site classification was 4CaT2S5. Right ureteric reimplantation was performed uneventfully. We herein emphasize that the development of a delayed type of ureteric injury is a possible associated complication of transobturator mesh surgery for the prolapse.

Randomized Controlled Trial Comparing Two Procedures for Anterior Vaginal Wall Prolapse

To compare success rates between anterior colporrhaphy and abdominal paravaginal defect repair for treatment of anterior vaginal wall prolapse. This was a prospective randomized controlled trial comparing anterior colporrhaphy plus polyglactin 910 mesh (vaginal) to paravaginal defect repair (abdominal) in women with symptomatic anterior vaginal wall prolapse. Pelvic organ prolapse quantification staging (POP-Q), pelvic floor distress inventory, pelvic floor impact questionnaire, and pelvic organ prolapse/urinary incontinence sexual questionnaires were administered pre and post-operatively. Women were followed up to 2 years. The primary outcome was anterior POP-Q stage, with failure defined as ≥stage II. We enrolled 70 patients, 35 in each group. Demographic and most peri-operative characteristics were similar between the groups. Mean anterior vaginal wall prolapse repair time (39 min) was shorter for vaginal versus abdominal repair (60 min; P < 0.001), with more concurrent hysterectomies in the vaginal (71%) versus abdominal group (42%), P = 0.01. At 2 years, objective failure rates for the vaginal and abdominal groups were 32% and 40%, respectively, P = 0.56. Subjective failure rates were lower and similar for both groups. Patient satisfaction rates were 88% for the vaginal and 73% for the abdominal group, P = 0.11. Quality of life questionnaires showed significant improvement from baseline but no difference between the groups (P = 0.12). At 2 years follow-up, anterior colporrhaphy with polyglactin 910 mesh and abdominal paravaginal defect repair have similar success rates, with most objective failures being asymptomatic.

Women's quality of life and sexual function after transvaginal anterior repair with mesh insertion

Current evidence about the impact of pelvic floor surgery on sexual function is conflicting. Only a few studies have reported with validated questionnaires on sexual function after transvaginal mesh repair, with a discrepancy in reported outcomes. The aim of this study was to prospectively explore the impact of anterior repair (AR) with mesh insertion on sexual function, quality of life and dyspareunia. 69 women with symptomatic stage II or greater prolapse exclusively of the anterior compartment participated in a prospective study on safety and efficacy of two mesh implantation techniques for anterior vaginal wall prolapse repair between September 2007 and May 2009. They were invited to complete the validated condition-specific short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and quality of life (QoL) questionnaires (Pelvic Organ Prolapse (POP) Distress Inventory (POPDI), Urinary Distress Inventory (UDI), POP Impact Questionnaire (POPIQ), and Urinary Impact Questionnaire (UIQ)) pre-operatively and 6 months post-operatively. All data were processed and analyzed in Statistical Computing Environment R, version 2.9.1. A significant decrease of Qol scores and a significant increase of PISQ-12 scores occurred after surgery. All sexually active women resumed sexual activity postoperatively. The majority of non-sexually active women remained sexually inactive. Postoperatively the frequency of pain during intercourse increased in 31% of cases and decreased or stayed unchanged in 69% of cases. The incidence of de novo dyspareunia after mesh repair was 4% while the incidence of dyspareunia slightly increased from 25% to 29% postoperatively. The results of this study suggest no deterioration in sexual function, a significant improvement in quality of life and a low incidence of de novo dyspareunia six months after AR with mesh insertion. Despite these findings, the majority of non-sexually active women remain sexually inactive postoperatively. These conclusions should be confirmed in a longer follow-up.

A Predictive Factor in Overactive Bladder Symptoms Improvement after Combined Anterior Vaginal Wall Prolapse Repair: A Pilot Study

PurposeWe aimed to determine whether a preoperative urodynamic parameter is a valuable predictor for the persistence of OAB symptoms after the AVP repair.Materials and Methods65 OAB patients with concomitant POP-Q stage III, IV anterior vaginal wall prolapse underwent a surgical repair were involved. All the patients were subjected to a preoperative urodynamic study, for whom the OABSS on questionnaire were preoperatively recorded. We firstly analyzed the correlation between the BOOI and the OABSS, then randomly divided patients into two groups: the group A (high PdetQmax, BOOI≥20) and the group B (low PdetQmax, BOOI<20). In each group, the OABSS was repeatedly measured post-operatively and the change were analyzed.Results31 patients were classified as the group A and 34 patients were classified as the group B. The group B showed significant decrease of symptom score in daytime frequency (p<0.01), urgency (p=0.04), urge incontinence (p=0.03), nocturnal frequency (p=0.01) and total score (p=0.01). The group A showed no significant decrease of symptom score in daytime frequency (p=0.42), urgency (p=0.61), urge incontinence (p=0.3), total score (p=0.15) except nocturnal frequency (p=0.01).ConclusionsA preoperative pressure-flow study can be a valuable tool in predicting the OAB symptoms change after the combined AVP repair. While the AVP repair leads to the improvement of OAB symptoms generally, some patients with a higher preoperative PdetQmax are still in need of the additional medical treatment.

1675 IMPACT OF TRANSLABIAL ULTRASOUND ON DIAGNOSIS AND TREATMENT OF MESH RELATED COMPLICATIONS

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology II1 Apr 20101675 IMPACT OF TRANSLABIAL ULTRASOUND ON DIAGNOSIS AND TREATMENT OF MESH RELATED COMPLICATIONS Andrea Staack, Chad Z. Baxter, Una Lee, Shelby Morrisroe, Ja-Hong Kim, Larissa Rodriguez, and Shlomo Raz Andrea StaackAndrea Staack More articles by this author , Chad Z. BaxterChad Z. Baxter More articles by this author , Una LeeUna Lee More articles by this author , Shelby MorrisroeShelby Morrisroe More articles by this author , Ja-Hong KimJa-Hong Kim More articles by this author , Larissa RodriguezLarissa Rodriguez More articles by this author , and Shlomo RazShlomo Raz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1499AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The prevalence of patients presenting with mesh related complications at our tertiary center is increasing. Symptom assessment, clinical examination and cystoscopy help to elucidate mesh complications, however, there are diagnostic limits. Surgical reports on patient's history of previous prolapse or incontinence repair utilizing mesh are often missing. The purpose of the study was to evaluate ultrasound (US) as a diagnostic method to locate the mesh, to evaluate underlying symptoms, and to guide the surgical approach of removal. METHODS Between 01/09 and 09/09 15 consecutive patients came to our tertiary referral center with mesh related complications. In a prospective observational study all patients were evaluated for clinical symptoms and findings on 2-D translabial US. Coronal, sagittal, and axial views were obtained with a curved transducer and evaluated. RESULTS Mean age was 56.2 years (range 38-82). Out of 15 patients of the total patient population seven had undergone a periurethral sling procedure only, two a sling and concomitant anterior vaginal wall prolapse (AVW) repair, one an isolated posterior wall (PVW) repair, two a sling and concomitant AVW and PVW repair, one an isolated AVW repair, and two an AVW and concomitant PVW repair. Patients main complains were dyspareunia (n=10), LUTS (n=13), pelvic pain (n=10), recurrent UTI (n=4), recurrent SUI (n=5), vaginal fullness (n=4), and autoimmune reaction requiring immunosuppressive therapy (n=1). All patients underwent translabial US. Mesh dislocation, folding, shrinkage, or disruptions were seen in 12 patients (80%). Of 10 patients, who had undergone a suburethral sling procedure, 8 patients presented sonographically with misplaced or folded mesh and 2 with a cystic lesion or foreign body granuloma periurethrally. All AVW patients (n=8) presented sonographically with mesh dislocation, folding, and shrinkages. A recurrent cystocele was found in 6 patients. Five patients underwent a posterior repair. Translabial US detected mesh dislocation on all patients and a recurrent rectocele in 4 patients. CONCLUSIONS US is the only diagnostic method to evaluate mesh, to detect dislocation, folding, misplacement, or shrinkage. Translabial US can differentiate between symptoms related or unrelated to mesh complications. It is a useful cost-efficient and non-invasive tool to localize misplacement and to determine the best surgical approach for mesh removal. Los Angeles, CA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e647 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrea Staack More articles by this author Chad Z. Baxter More articles by this author Una Lee More articles by this author Shelby Morrisroe More articles by this author Ja-Hong Kim More articles by this author Larissa Rodriguez More articles by this author Shlomo Raz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Results of Cystocele Repair: A Comparison of Traditional Anterior Colporrhaphy, Polypropylene Mesh and Porcine Dermis

Because traditional anterior colporrhaphy can have a high recurrence rate, we assessed the recurrence rate of 3 methods of cystocele repair, including 1) traditional anterior colporrhaphy, 2) repair using porcine dermis interposition graft and 3) repair using polypropylene mesh. Additionally, we compared the rate of erosion of porcine dermal graft with that of polypropylene mesh. The records of patients who underwent cystocele repair by the same urologist using porcine dermal graft, polypropylene mesh or traditional repair from January 1999 to August 2005 were reviewed. Data were collected on history, physical examination, outcomes and complications. Using the Baden-Walker system a cystocele of grade 2 or higher on followup examination was considered recurrence. A total of 119 patients underwent cystocele repair from January 1999 to August 2005. Followup was available on 99 patients and it averaged 13.5 months (range 2 to 46). Of the patients 56 (57%) underwent cystocele repair using porcine dermal graft, 25 (25%) received polypropylene mesh and 18 (18%) underwent traditional repair. Of the 99 patients 22 (22%) had cystocele recurrence. Based on the type of repair 36% of patients (20 of 56) with porcine dermal grafts had recurrence compared to 4% (1 of 25) and 6% (1 of 18) using polypropylene and traditional repair, respectively. Mean time to cystocele recurrence was 4.9 months (range 0.5 to 20). A total of 12 patients (21%) had extrusion of porcine grafts through the anterior vaginal wall incision compared to 1 (4%) with polypropylene mesh. In our patient population the short-term failure rate for anterior vaginal wall prolapse using porcine dermis interposition graft was higher than that for traditional anterior colporrhaphy or polypropylene mesh. In addition, the incidence of vaginal extrusion of porcine graft was unacceptably high. Porcine dermis is a less suitable material for cystocele repair than polypropylene mesh or traditional anterior colporrhaphy. Prospective, randomized trials are necessary to determine the true efficacy and complication rates of these graft materials for anterior vaginal wall prolapse repair.

Do overactive bladder symptoms improve after repair of anterior vaginal wall prolapse?

This study aims to evaluate the changes of overactive bladder symptoms to anterior vaginal wall prolapse repair. Ninety-three consecutive women with symptomatic anterior vaginal wall prolapse >or= stage II and coexistent overactive bladder symptoms were prospectively studied using a urinalysis, urodynamics, King's Health Questionnaire (KHQ), Prolapse Quality of Life (P-QOL) questionnaire and pelvic organ prolapse quantification (POP-Q) system before and 1 year after surgery. All women underwent a standard fascial anterior repair. Postoperatively, urinary frequency, urgency and urge incontinence disappeared in 60, 70 and 82% of women respectively (p value < 0.001). The vaginal examination findings as well as the quality of life of the women assessed using KHQ and P-QOL significantly improved after surgery (p value < 0.001). This study has demonstrated that anterior vaginal repair does produce significant improvement in overactive bladder symptoms. A larger longer-term study is required to assess if these changes persist over time.

Nueva técnica de reparación de los defectos del compartimento anterior mediante implante sintético y cubierta biológica: abordaje, fijación y anclaje transobturador

Transobturator systems for anterior vaginal wall prolapse repair exemplify the current trend in pelvic floor surgery. They may be considered an approach and also a mesh fixation system, in opposition to free mesh cystocele repair where they work by the creation of fibrotic tissue after mesh implant (biological or synthetic). To describe the elements of the Avaulta anterior system, its indications and the surgical technique to implant it and adequately adjust it. The operation has five steps: (1) midline vaginal incision and mucosal dissection, (2) Obturator foramen identification, design and performance of 2 superior mini incisions in both the genitofemoral folds, and another two 3 cm below and 1-2 cm lateral to them, (3) Needle introduction and passage through the upper portion of the obturator foramen, parallel to the ischiopubic ramus, and once past needle charging with the arm of the implant, (4) Needle introduction and passage from the inferior incisions vertically through the inferior portion of the obturator foramen, directing the needle with bimanual control to the theoretical localization of the uterine.cervix, with connection and charging of the inferior arm of the mesh. (5) Tension free adjustment of the mesh and closure of the incisions. (1) It is a reproducible technique that adequately corrects the anterior vaginal compartment defects. (2) The design and technology of Avaulta aims to correct the anterior compartment defects, based on the principles of ideal mesh.