Single-incision vaginal approach to treat cystocele and vault prolapse with an anterior wall mesh anchored apically to the sacrospinous ligaments

Abstract

Introduction and hypothesis: The safety and early efficacy of a new technique to treat cystocele and/or concomitant apical prolapse through a single vaginal incision with a lightweight mesh anchored apically bilaterally to the sacrospinous ligaments is reported.

Methods: Women with anterior compartment and/or apical prolapse ≥ stage II underwent repair through a single anterior vaginal wall incision with the Anterior Elevate System (AES). The technique utilizes a lightweight (24 g/m(2)) type I mesh anchored to the sacrospinous ligaments via two mesh arms with small self-fixating tips. The bladder neck portion of the graft is anchored to the obturator internus with similar self-fixating tips. The apical portion of the graft is adjustable to vaginal length prior to locking in place. Outcome measures included prolapse degree at last follow-up visit, intra/post-operative complications, and QOL assessments.

Results: Sixty patients were implanted with average follow-up of 13.4 months (range 3-24 months). Mean pre-op Ba was +2.04 ± 1.3 and C -2.7 ± 2.9. Average blood loss was 47 cc and average hospital stay was 23 h. Sixty-two percent of patients had concomitant sling for SUI. Mean post-op Ba is -2.45 ± 0.9 and C -8.3 ± 0.9. There was no statistical difference in pre- to post-op TVL. Objective cure rate at current follow-up is 91.7% (≤ stage 1). To date, there have been no mesh extrusions. No patients have reported significant buttock or leg pain. No patients have required surgical revision for any reason.

Conclusion: The AES is a minimally invasive technique to treat anterior compartment and/or apical prolapse through a single vaginal incision. Initial results show the procedure to be safe and early efficacy is promising. Longer-term follow-up is ongoing.

Fig. 1

Apical arm of the Elevate system placed into the sacropinous ligament 2 cm medial to the ischial spine. (Reproduced with permission from AMS)

Fig. 2

Close-up view of the small self-fixating tip attaching into the ligament (Reproduced with permission from AMS)

Fig. 3

Final adjustment of the graft into place. The bladder neck portion of the graft has been fixated to the levators and the apical portion of the graft is slid up the arms in a tension-free manner to elevate the anterior wall and vault. (Reproduced with permission from AMS)