Category: Reconstruction: Outcomes & Complications

MP14-17 - Repair of Cystocele and Apical Genital Prolapse Using 6-Strap Sling Mesh Implant

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective :

Objective: to assess the outcomes of surgical repair of anterior apical prolapse using the 6-strap sling mesh implant.

Methods : the prospective study included 100 patients with genitourinary prolapse. The follow-up time was 12 to 72 months. The anatomical outcomes according to the POP-Q system and intra- and postoperative complications were assessed. Stage II and higher prolapse was considered to be a recurrence. The quality of life and sexual function were assessed using PFDI-20, PFIQ-7, and PSIQ-12.

Results :

the age of the patients varied between 34 and 76 years. All patients had stage III cystocele. The anterior vaginal wall descent in all the patients was associated with uterine descent (in 37 (37%), stage II; in 63 (63%), stage III). Twenty-one patients (21%) underwent colpoperineorrhaphy with levator repair using the standard method for stage II and stage III rectocele. One patient had preoperative stress urinary incontinence, which persisted after surgery. In three observations (3%), stress urinary incontinence was overcome using the 6-strap sling mesh implant without the simultaneous use of a midurethral sling. Urinary incontinence occurred de novo in eight (8%) patients. No postoperative dyspareunia was revealed. The following postoperative complications were observed: five anterior vaginal wall hematomas, which resorbed over six to nine weeks; one 250-mL paravesicular fat hematoma whose resorption time was four months; nine patients with dynamic ischuria resolved in the period of 3–7 postoperative days; short-term hyperthermia up to 38.5°C was noted in seven patients; vaginal wall erosions in the region of the operative wound were found in two observations in the long-term postoperative period (>3 months). In one case, the treatment of erosion required excision of redundant tissue.

Conclusions : genitourinary prolapse repair using 6-strap sling mesh is efficacious and relatively safe. The method demonstrates good anatomical results in relation to both anterior and apical prolapses. A comparatively low complication rate and insignificance of postoperative complications were noted. This technique does not envisage posterior vaginal wall repair. In the case of significant rectocele (> stage II), colpoperineorrhaphy with levator repair is possible. According to the outcomes of the four-year follow-up, the procedure of placement of a light-weight six-strap sling mesh using a transvaginal approach is possible and efficacious in the treatment of anterior apical genitourinary prolapse.

Olesya Snurnitsyna

Moscow, Moskva, Russia

Petr Glybochko

moscow, Moskva, Russia

Leonid Rapoport

moscow, Moskva, Russia

Mikhail Enikeev

Head of Department
Sechenov University
Moscow, Moskva, Russia