Tension-free vaginal mesh repair for anterior vaginal wall prolapse

Objectives: We determined the efficacy of the use of a tension free prolene mesh to correct a grade III anterior vaginal wall prolapse recurrence. Methods: Twelve women (mean age 65.6 years) with stress urinary incontinenc e (SUI) (4 type II and 1 type III) and bladder prolapse entered the study. After vaginal incision a pretailored polypropylene mesh was fixed to its fo ur angles by absorbable sutures to the urethropelvic ligaments and pubocerv ical fascia anteriorly and to the cardinal ligaments and pubocervical fasci a posteriorly. When present, a posterior descensus was corrected during the same procedure. SUI was treated with the tension-free vaginal tape procedu re (TVT) through a separate vaginal incision over the mid-urethra. Results: All patients were available for postoperative pelvic examination a t 3-month intervals, for a mean follow-up of 20.5 months (range 15-32). Nin e patients were considered cured (no cystocele recurrence) while in 3 patie nts a grade 1 asymptomatic cystocele was present postoperatively (asymptoma tic). No significant postoperative pain was reported by the patients. Conclusions: This study confirms that in patients with moderate cystocele a tension-free mesh to support bladder base and neck effectively treats the cystocele. It is particularly recommended in the treatment of previous fail ure with traditional techniques and when the quality of suspending tissue i s poor or defective, A long-term study on a large number of patients is sti ll warranted to confirm and validate its clinical use. Copyright (C) 2000 S . Karger AG, Basel.