[Cystocele repair by the vaginal route with a tension-free sub-bladder prosthesis]

Abstract

Objective: To describe a new vaginal approach for the repair of cystoceles, reinforced with a tension-free polypropylene mesh.

Methods: The vaginal procedure consisted of a complete dissection of the cystocele and a thorough entry from the vesicovaginal space under the inferior pubic ramus into the retropubic space. The polypropylene mesh (GyneMesh(TM), Gynecare, Ethicon France) was placed from the retropubic space to the inferior part of the bladder in a tension-free fashion.

Results: Forty-eight consecutive women with grade 3-4 cystoceles underwent this procedure between October 1999 and September 2001. Mean age was 63.9 years (41-85). Mean follow-up is 18 months (8-32). The success rate was 97.9%. There were a total of four vaginal erosions of the mesh (8.3%). There were no postoperative infections of the mesh.

Conclusion: The vaginal repair of severe cystocele reinforced with a tension-free polypropylene mesh is a simple and reproducible technique, with high success rate and low morbidity.