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Minimally invasive cystocele repair technique using a polypropylene mesh introduced with the transobturator route
Hazem Samour1, Amgad Abougamra, Haitam A M Sabaa
1Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Al Waili, Cairo Governorate, Cairo, 11762, Egypt.
Purpose:
Evaluation of the safety and efficacy of the use of polypropylene mesh for cystocele repair using minimally invasive technique.
Methods:
We retrospectively evaluated the perioperative events, short-term postoperative side-effects, and follow up for 152 patients who underwent repair for cystocele grade 2 or more using a polypropylene mesh. The repair was performed through a small anterior vaginal wall incision, with the arms of the mesh passed through a transobturator route using a corkscrew needle. Stress urinary incontinence (SUI) tests and the International Continence Society Pelvic Organ Prolapse Quantification (POP-Q) staging systems were documented before and after surgery.
Results:
The average time and blood loss for the procedure were 18 min and 100 cc, respectively. Bladder injury and excess bleeding (>500 cc) occurred in one and two cases during the procedure, respectively. The early postoperative complications included pain (10.5 %), mesh erosion (1.3 %), fever (1.3 %), and urinary tract infection (7.9 %). Among the 122 patients who were followed up (median follow-up time, 18.2 months), the subjective and objective cure rates for the prolapse were 98 and 95 %, respectively. Complications during the follow up included mesh erosion (four cases) and persistent dyspareunia (four cases).
Conclusions:
Cystocele repair with mesh placement through transobturator route can be considered a minimally invasive, promising method for the correction of cystocele and SUI based on the low rate of complications, the high rate of success, and the low incidence of recurrence.
Insights
This study shows polypropylene mesh repair for cystocele is safe and effective. The minimally invasive transobturator approach offers high success rates for pelvic organ prolapse and stress urinary incontinence.
Area of Science:
- Urogynecology
- Minimally Invasive Surgery
- Pelvic Floor Disorders
Background:
- Cystocele, a common pelvic organ prolapse, significantly impacts women's quality of life.
- Surgical correction is often necessary for symptomatic cystocele and co-existing stress urinary incontinence (SUI).
Purpose of the Study:
- To evaluate the safety and efficacy of polypropylene mesh for cystocele repair.
- To assess a minimally invasive surgical technique utilizing a transobturator route.
Main Methods:
- Retrospective review of 152 patients with cystocele grade 2 or higher undergoing mesh repair.
- Transobturator mesh placement via a small vaginal incision.
- Pre- and post-operative assessment using stress urinary incontinence tests and POP-Q staging.
Main Results:
- Average procedure time: 18 minutes; average blood loss: 100 cc.
- Low perioperative complications; early postoperative issues included pain (10.5%) and mesh erosion (1.3%).
- High cure rates at 18.2 months median follow-up: 98% subjective, 95% objective; late complications included mesh erosion and dyspareunia.
Conclusions:
- Transobturator mesh repair is a promising, minimally invasive option for cystocele and SUI.
- The technique demonstrates a favorable safety profile with high success rates and low recurrence.
- This method offers effective correction for pelvic organ prolapse and associated urinary symptoms.
