Vaginal anterior repairing and Kelly plication is the
classical procedure for treatment of cystocele
3. Central
defects are generally repaired via fasial plication. In
addition to these operations, paravaginal reinforcement
and Burch colposuspesion can be used
4. However,
this procedure needs laparotomy which extends
hospitalization during this operation. Vaginal operations
are preferred because of short hospitalization period and
with minimal morbidity
5.
Severe cystocele repair should include correction of
bladder herniation and without obstruction and retention.
Tension-free mesh is placed under the bladder wall and
resistance to intrabdominal pressure is increased at the
same time with permenant reinforcement of bladder
basement,neck and side walls6.
We didn't detect any recurrence of symptomatic
cystocele or stage 1 cystocele after operation in our 26
patients with stage 2 or more cystocele. ICIQ-SF scores
significantly decreased in the postoperative period
(14.9±2.4 versus 5.2±4.7) in our study group (p < 0,01).
Flood et al.7 assessed the use of Marlex mesh in
conjunction with anterior colporrhaphy for the correction
of cystocele with or without urinary stress incontinence in
142 patients. Their mean follow-up time was 3.2 years.
No patients experienced recurrent anterior vaginal wall
prolapse but three of their patients (2.1%) developed
mesh erosions in the vagina. There was a 74% success
rate in the treatment of urinary stress incontinence. In our
study we had also three patients with vaginal erosions
(11.5%). Since, initially we had no enough experience
with this technique in our hospital, a relatively high
complication rate appeared in our study.
Yan et al.8 studied cystocele repair by the
placement of a synthetic subvesical mesh secured
anteriorly through the obturator foramen in 30 patients.
They only found failure in a young patient (3%) after a
mean follow-up of 6.7 months. Two vaginal erosions
(7%) were observed at six and nine months
postoperatively. Two cases (14%) complained of anterior
dysparaunia.
Granese et al.9, repaired moderate or severe
cystocele with Y-shaped mesh placed on the perivesical
fascia. After a follow-up of 24 months,19 patients (11%)
reported recurrent cystocele, 9 patients (5.1%) had a
vaginal wall erosion after 6 month follow up and 2
patients (1%) complained of persistent dyspareunia.
Palanca et al.10, used polypropylene mesh for the treatment of cystocele in 31 cases whose mean age was
62.3 year. They found no patient with prolapse
recurrence.
Park et al.11 reported success rate of cystocele
repair as 90% and stress incontinence was cured in all
patients (100%). The postoperative complication was
transient voiding difficulty in 2 cases after mean follow up
7.1 month in.
The use of mesh in operations isn't always safe.
Cicatrix formation and erosion rate was reported to be
6% in some series12,13. Infection, pain, seroma,
fıstula and sinus formation were reported to be other
complications in mesh operations. Type 1 monofilament
polypropylene macroporous mesh should be preferred
because of low complication rates13.
As a conclusion, the use of one piece of
polypropylene mesh for the support of bladder and
midurethra in cases with combined cystocele and stres
urinary incontinence may be accepted as a successful,
effective method of treatment with low morbidity and well
tolerebility.