Vaginal Cystocele Research Articles

Vaginal Cystocele Cure at Bouake University Hospital (Chu): Anatomical and Functional Results

Vaginal Cystocele Cure at Bouake University Hospital (Chu): Anatomical and Functional Results

Vaginal cystocele repair and hysteropexy in women with anterior and central compartment prolapse: efficacy and safety after 30months of follow-up.

The aim of this study was to assess the safety and efficacy of vaginal native tissue repair and uterine suspension after a follow-up of at least 1year. We included all consecutive women with an anterior vaginal prolapse of stage II or higher and a concomitant uterine prolapse of stage II who underwent this surgical procedure. We considered women with a descensus with maximum point of less than -1 in any compartment as objectively cured. Overall success was defined as no prolapse symptoms, together with a Patient Global Impression of Improvement (PGI-I) score of 2 or less, prolapse of stage lower than II, and no need for other surgery. A total of 102 patients underwent this surgical procedure during the study period and met all the inclusion criteria for statistical analysis. The mean follow-up was 31±8.2months; no patient was lost to follow-up. Five patients (4.9%) showed postoperative complications. In terms of subjective outcomes, at the last available follow-up, failure of this surgical procedure was seen in 2% of patients. The objective cure rate and the overall cure rate were the 95.1%. No significant deterioration in objective cure rates was observed over time (p=0.6). Vaginal repair and hysteropexy appear to be an effective and safe option for women with advanced uterovaginal prolapse.

Safety of Mesh for Vaginal Cystocele Repair: Analysis of National Patient Characteristics and Complications

The use of mesh in vaginal cystocele repair has decreased. We analyzed the ACS NSQIP® (American College of Surgeons National Surgical Quality Improvement Project) database to compare outcomes of repairs with and without mesh. CPT was used to identify patients who underwent cystocele repair with and without mesh from 2006 to 2013. Patient characteristics and complications were analyzed. We identified 6,849 patients, of whom 5,667 (82.5%) underwent native tissue repair and 1,182 (17.5%) underwent repair with mesh. Patients who received mesh were older (mean ± SD age 64 ± 11 vs 60 ± 12 years, p <0.001) and more had comorbidities (56% vs 47%, p <0.001). Mean mesh vs nonmesh operative time (97 ± 67 vs 95 ± 53 minutes, p = 0.2) and mean length of stay (1.3± 2.4 vs 1.4 ± 1.3 days, p = 0.2) were similar in the 2 groups. Urinary tract infection was the most common complication in cases without vs with mesh (3.8% vs 3.5%). Mesh procedure rates of mortality (0% vs 0.3%, p = 0.04) and overall surgical complications (1.8% vs 3.9% p <0.001) were higher. On multivariate analysis ASA® class 3 or greater (OR 1.4, p = 0.01), longer operative time (OR 1.004, p <0.001) and mesh (OR 1.32, p = 0.05) were associated with greater morbidity. Patient comorbidities, surgeon specialty and concomitant procedures did not confer an increased risk of complications. Native tissue repair is performed more commonly than mesh repair. ASA class, operative time and mesh use are associated with an increased risk of postoperative morbidity. These results suggest an increased risk of complications when using mesh in vaginal anterior repair, although the overall risk in each procedure was low.

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

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.

OP34.09: Ultrasonographic scan evaluation of synthetic mesh used for vaginal cystocele repair comparing two techniques at 1 year follow up

The main objective is ultrasonographic (US) evolution of synthetic mesh at 1 year follow up and its correlation with clinical outcome. In 2010, we included prospectively 33 patients, 15 with trans obturator mesh Ugytex™ (Sofradi, COVIDIEN) (TO), and 18 with bilateral anterior sacrospinous ligament and arcus tendineus suspension Pinnacle™ (Boston Scientific) (SE) mesh for vaginal cystocele repair. The mesh was measured pre operatively (PO). US scan was performed 2D/3D, intra vaginal and trans perineal, 3 day (D3) and 6 week (W6) and at one year (Y1) follow up. We evaluated mid-sagittal length of the mesh, anatomic place and distance to bladder neck. We defined the “arc” of the mesh, distance between the two most opposite points of the mesh. Clinical examination with POP-Q was done at each follow up. We sought a correlation between clinical recurrence at 1 year follow up and US at 6 weeks. All meshes were visualized. A decrease in the total length is noticed for (TO) [W6: 40 ± 9 mm to Y1: 36 ± 9 mm] not observed for (SE) meshes [W6: 45 ± 12 mm Y1: 45 ± 13 mm]. At Y1, the (TO) mesh correspond to 66% of the initial mesh measured by US at D3 versus 88% for the (SE) mesh. There is a better place for the spreading of the (SE) meshes. The sagittal arcus at W6 is a prognostic factor of its at Y1 because it no longer changes: (TO) 32 ± 8 mm and (SE) 40 ± 8 mm. We have two cases of recurrent cystocele of grade 2 for (TO) meshes and one for (SE) meshes. In these 3 cases, recurrence is located in the lower part of the anterior vagina (between mesh and bladder neck) (bladder neck mesh distance 19 ± 4 mm vs. 4 ± 4 mm, P < .05). Mesh (SE) do not decrease in size between W6 and Y1 compared with (TO). Ultrasound at 6 weeks appears to define a situation at risk of clinical recurrence by placement of the mesh relative to the bladder neck. The type of prosthesis tension free fixation seems to predefine its evolution (size) in time mesh shrinkage was due partly to its method of installation.

Transvaginal Cystocele Repair Using Pursestring Technique Reinforced With Custom-tailored Two-armed Mesh

To evaluate the efficacy and safety of vaginal cystocele repair using a pursestring suture technique reinforced with custom-tailored 2-armed mesh. The records of patients who underwent isolated cystocele repair by a single surgeon were retrospectively reviewed. All women were assessed by clinical examination and lower urinary tract symptoms preoperatively and at 3 and 6 months and every year postoperatively. The principal outcome measure was anatomic cure (stage 1 or lower) assessed by the Pelvic Organ Prolapse Quantification system. From May 2005 to June 2009, 50 consecutive patients with minimum stage 2 (Aa or Ba 0) cystocele were treated using the procedure. The mean follow-up was 24 months (range 12-54), and the success rate was 96% (48 of 50). No intraoperative complications occurred. Two developed vaginal erosion (4%) and underwent excision of the extruded mesh smoothly. The final 21 consecutive patients underwent urodynamic assessment pre- and postoperatively. Compared with the baseline urodynamic findings, surgery resulted in decreased maximal urethral pressure and maximal urethral closure pressures. However, neither increased de novo incontinence nor reduced cystometric bladder capacity developed. The use of the pursestring suture technique reinforced with custom-tailored 2-armed mesh for vaginal cystocele repair is safe, effective, and economic.

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

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.

Primary Vaginal Stone in a Young Active Woman

Vaginal stones are rare. Most gynecologists may never see a vaginal stone case throughout their career. The earliest reported case was in 1900, in which a stone formed in a vaginal cystocele [1]. Most vaginal stones are derived from the deposition of urinary salt. Stones consisting of phleboliths in the venous plexus of the vaginal wall [1] and primary vaginal calculus of hematic origin in an unmarried woman with a congenital vaginal septum [2] were reported. They were classified as primary and secondary stones. Primary vaginal stones are believed to originate from the stasis of urine in the vagina without an obvious nidus, whereas secondary vaginal stones are the result of crystallization of urinary constituents around a foreign body in the vagina [3]. A 24-year-old unmarried woman visited our gynecologic clinic because of dyspareunia. She had undergone surgery for imperforate anus shortly after her birth, and she had regular menstruation during her adolescence. Pelvic examination found a transverse vaginal septum at the middle portion of the vagina with a central perforation of approximately 1 cm in diameter. Her urethra opening was about 1 cm below the usual site. It became part of the vagina, close to the vaginal orifice. This condition is so called hypospadias in female patients. Magnetic resonance imaging showed a double uterus, bilateral hydrosalpinx, and two vaginal stones in the upper part of the vagina (Figures 1 and 2). The perforated hole on the transverse vaginal septum was dilated using a Hegar dilator and finger. Two smooth surfaced, darkish stones with offensive odor measuring 4 × 3 × 1 cm and 2.1 × 0.8 × 0.4 cm were found behind the septum and were removed using ring forceps (Figure 3). Stone analysis was performed at the

A New Operation for the Cure of Vaginal Cystocele*

A New Operation for the Cure of Vaginal Cystocele*

New Operation for the Cure of Vaginal Cystocele

New Operation for the Cure of Vaginal Cystocele