Vaginal repair of cystocele with anterior wall mesh via transobturator route: efficacy and complications with up to 3-year followup

Robert D Moore, John R Miklos, Robert D Moore, John R Miklos

Abstract

Study objective: The objective of this study was to report on the safety and efficacy of cystocele repair with anterior wall mesh placed via a transobturator route (Perigee system, AMS, Minnetonka, MN).

Design: Single center retrospective study.

Setting: Single center hospital setting and Urogynecology practice in the United States.

Patients: 77 women presenting with symptomatic anterior wall prolapse.

Intervention: Repair of cystocele with an anterior wall Type I soft-polypropylene mesh placed via a transobturator approach. Concomitant procedures in other compartment were also completed as indicated.

Measurements and main results: 77 women underwent the Perigee procedure at our institution over a 2-year period. The mesh was attached to the pelvic sidewalls at the level of the bladder neck and near the ischial spine apically with needles passed through the groins and obturator space. Mean follow-up was 18.2 months (range 3-36 months). Objective cure rate was 93%. Subjectively only two patients have had recurrent symptoms of prolapse, and only 1 of these has required repeat surgery for cystocele. Mesh exposure vaginally occurred in 5 patients (6.5%); however all were treated with estrogen and/or local excision of exposed mesh and had no further sequelae. There were no incidences of chronic pain, infection, or abscess, and no patient required complete mesh removal for infection, pain, or extrusion.

Conclusion: In select patients with anterior wall prolapse, repair with mesh augmentation via the transobturator route is a safe and effective procedure with up to 3 years of follow-up.

Figures

Figure 1
Figure 1
Inferior or “apical” needle being passed through the obturator space to attach the more apical arm of the mesh graft to the pelvic sidewall at the level of the ischial spine.
Figure 2
Figure 2
Final positioning of the mesh providing support under the bladder.

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Source: PubMed

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