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Anterior vaginal compartment surgery.

Christopher Maher¹

¹Royal Brisbane and Wesley Urogynaecology, University of Queensland, 30 Chaseley Street, Auchenflower, 4067, Brisbane, Australia, chrismaher@urogynaecology.com.au.

International Urogynecology Journal

|October 22, 2013

Summary

Anterior vaginal compartment prolapse surgery using polypropylene mesh improves anatomical outcomes but increases mesh complications. Native tissue repair with absorbable mesh or biological grafts shows improved anatomical results without increased complications.

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Area of Science:

Urogynecology
Pelvic reconstructive surgery
Surgical innovation

Background:

Pelvic organ prolapse (POP) affects many women, with the anterior vaginal compartment being a common site.
Surgical repair aims to restore anatomy and function, with various graft materials and techniques employed.
Evidence-based guidelines are crucial for optimizing surgical outcomes and patient safety.

Purpose of the Study:

To systematically review the safety and efficacy of surgical procedures for anterior vaginal compartment pelvic organ prolapse.
To evaluate different graft materials, including synthetic mesh and biological grafts, in comparison to native tissue repair.
To provide evidence-based recommendations for surgical management.

Main Methods:

Comprehensive literature search of English-language studies up to January 2012 in PubMed, Medline, Cochrane Library, and Cochrane Database of Systematic Reviews.

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Classification of publications by level of evidence (Level 1-4) based on study design.

Application of the Oxford grading system for evidence-based recommendations (Grade A-D).

Main Results:

Absorbable mesh augmentation and biological grafts improved anatomical outcomes compared to native tissue repair alone (Grade B).
Polypropylene mesh demonstrated superior anatomical outcomes versus biological grafts but had a significantly higher mesh exposure rate (Grade A).
Anterior transvaginal polypropylene mesh showed better subjective and objective outcomes than anterior colporrhaphy but was associated with increased operating time, blood loss, and mesh extrusion rates (Grade A/B).

Conclusions:

Polypropylene mesh in anterior compartment prolapse surgery offers enhanced objective and subjective outcomes.
These benefits must be weighed against the increased morbidity, including mesh extrusion, associated with transvaginal polypropylene mesh.
Further research may be needed to clarify the role of specific graft materials and surgical techniques.