A NEW OPERATION FOR GENITOURINARY PROLAPSE

Purpose: A new method to support female prolapsed pelvic organs is pre sented, which involves use of nonabsorbable mesh cut in a hammock shap e. The approach is transvaginal and the novelties are the way in which the mesh is anchored and its considerable size. Materials and Methods : The mesh is anchored transversally between the 2 arcus tendineus of the endopelvic fascia and in the anteroposterjor direction between the bladder and uterine necks. The anteroposterior dimension of the mesh must completely cover the cystocele. From January 1996 to June 1997 th is technique was used in 44 patients ranging in age from 43 to 86 year s. The patients presented with various degrees of incontinence and com binations of cystocele, uterine or vaginal vault prolapse, rectocele a nd/or enterocele. Cystocele and incontinence were classified according to the SEAPI QMM scales and the other anatomical defects according to the Beecham classification. Preoperative analysis of all patients inc luded cystography, video urodynamics, and pelvic and abdominal echogra phy. Results: All patients affected by some degree of incontinence wer e cured. Patients with prolapse without incontinence were completely s atisfied with the operation. Uterine prolapse was third degree in 6 of 20 patients and it partially recurred in 3. Cystography in all patien ts demonstrated excellent repair of the descensus. Sexual life and men ses did not change, and no pelvic fibrosis or hydroureteronephrosis oc curred. Followup ranges from 9 to 23 months (median 13.9). Conclusions : This technique has broad application and is simple to perform. Longe r followup will prove its merits definitively.