Horseshoe-shaped Marlex mesh for the treatment of pelvic floor prolapse

Objective: Pelvic prolapse results from weakness or damage to the normal pe lvic-support systems. The main support for The pelvic viscera is provided b y the pelvic fascia, which is naturally reinforced by urethra-pelvic ligame nts, cardinal ligaments and uterosacral ligaments. A polypropylene mesh (Ma rlex-Bard) was used as a genitourinary and rectal support in order to subst itute the damaged pelvic fascia. Methods: Sixteen consecutive females suffe ring from severe genitourinary prolapse entered the study. Using the HWS (B aden-Walker) classification 10 patients presented a grade-IV and 6 patients a grade-III cystocele, 7 patients a grade-III and 1 a grade-IV rectocele. Hysterocele of grade IV was present in 2 patients and in 5 patients grade I II. No enterocele was present at the pre-operative visit. Twelve patients s uffered from stress incontinence; one had obstructive urinary symptoms with postvoiding residual urine of >200 ml, All patients underwent urodynamic t ests and pre-operative cystography. The primary aim was prolapse reduction and continence. The operation, under general anesthesia, consisted of inser tion and fixation of a horseshoe-shaped Marlex mesh between pubis and sacru m to close the area between the pelvic viscera and inferior pelvic hiatus. Three patients underwent hysterectomy. Results and Conclusions: The follow- up ranged between 12 and 29 months. In 15 patients the prolapse was complet ely resolved and 13 were dry at follow-up. One patient presented a complete recurrence at the 3-month follow-up. Nine cases of pre-operative constipat ion were recovered after surgery. This technique seems to give promising re sults in the repair of genitourinary prolapse and stress incontinence. Copy right (C) 2001 S. Karger AG. Basel.