Use of cadaveric solvent-dehydrated fascia lata for cystocele repair - Preliminary results

Objectives. To present a surgical technique in which cadaveric fascia lata is used for cystocele repair, Methods. Twenty-one consecutive women (mean age 67 +/- 10 years) with sever e cystocele were prospectively enrolled. All patients underwent meticulous clinical and urodynamic preoperative evaluations. Solvent-dehydrated, Tutop last-processed, cadaveric fascia lata was used for cystocele repair. The fa scia was anchored transversally between the bilateral arcus tendineus and t he cardinal and uterosacral ligaments. Standard endopelvic plication was pe rformed thereafter as a second layer. Patients with overt or occult sphinct eric incontinence underwent concomitant pubovaginal sting (PVS) surgery as well, using the same material. The main outcome measures included recurrent urogenital prolapse, persistent or de novo urinary incontinence (stress or urge), and dyspareunia. Results. Of the 21 patients, 19 underwent concomitant PVS, 3 concomitant va ginal hysterectomy, and 8 posterior colporrhaphy in addition to their cysto cele repair. The mean follow-up was 20.1 +/- 6.7 months (range 12 to 30). N o postoperative complications related to the material or technique occurred . None of the patients developed a recurrent cystocele. Two patients (9%), one of whom underwent concomitant posterior colporrhaphy, developed mild re cto-enterocele at 4 to 6 months postoperatively. Six patients underwent con comitant PVS for occult sphincteric incontinence. None developed postoperat ive stress incontinence. Thirteen other patients underwent concomitant PVS for overt sphincteric incontinence. All but two were stress-continent posto peratively. One half of the patients with preoperative urge or mixed incont inence had persistent urge incontinence postoperatively. None of the patien ts developed postoperative de novo urge incontinence or dyspareunia. Conclusions. The use of solvent-de hydrated cadaveric fascia lata for cysto cele repair, as well as PVS, is associated with encouraging short and mediu m-term results. Long-term follow-up is needed to evaluate whether these res ults are durable. UROLOGY 58: 179-183, 2001. (C) 2001, Elsevier Science Inc .