Anatomical conditions for pelvic floor reconstruction with polypropylene implant and its application for the treatment of vaginal prolapse

Abstract

Objective: The purpose of the surgical treatment of vaginal prolapse is not only the restoration of the anatomy but also of the visceral functioning. To maintain the quality of life for patients with recurrent vaginal prolapse, to reduce the failure rates of operations and to avoid a colpectomy or a colpocleisis at the same time, synthetic materials have been introduced in transvaginal reconstructive surgery of the pelvic floor. The TVM Group from France described the reconstruction of the pelvic floor with polypropylene implants in 2004. The aim of this study is to determine the anatomical position of the polypropylene implants after reconstruction of each compartment of the pelvic floor and to determine the relation of the implants to the major neighbouring neurovascular structures on the basis of corpse dissections.

Study design: Following the technique of the TVM Group from France we present the pelvic floor reconstruction using Gynecare Prolift* (Ethicon, Sommerville, NJ, USA). To reach the aims of the study, anatomical dissections of the pelvic floor on three specially preserved anatomical specimens are performed after the placement of the implants.

Results: The anatomical dissections show that every defect in all three compartments of the pelvic floor can be repaired by using polypropylene implants. Between the implants and the major neighbouring neurovascular structures a safe distance exists with slight individual differences.

Conclusion: The pelvic floor reconstruction using polypropylene implants is a treatment option especially for the surgical correction of the recurrent vaginal prolapse. If the surgeon has thorough anatomical knowledge and performs the surgical technique in the recommended manner, injuries of the major neighbouring neurovascular structures will be avoided. Clinical studies will analyze the long-term results after pelvic floor reconstruction using polypropylene implants.