Simultaneous treatment of anterior vaginal wall prolapse and stress urinary incontinence by using transobturator four arms polypropylene mesh

To evaluate the medium-term efficacy and safety of transobturator four-arm polypropylene mesh in the treatment of high-stage anterior vaginal wall prolapse and concomitant stress urinary incontinence (SUI).

Between September 2010 and August 2013, a prospective single-center trial was performed to evaluate women with stageā‰„3 anterior vaginal wall prolapse with or without SUI who presented to Labbafinejad Hospital, Teheran, Iran, and underwent anterior vaginal wall repair with polypropylene mesh. Pre- and postoperative evaluation included history; physical examination using the Pelvic Organ Prolapse Quantification system and cough stress test, both before and after reduction of prolapsed structures; Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ); urinalysis and culture; and a postvoid residual assessment. Complications were reported at a mean of 2 years of follow-up.

A total of 71 patients underwent cystocele repair with the transobturator four-arm polypropylene mesh. Seven of the patients were lost to follow-up. There were no perioperative complications. The anatomical success rate was 87. 5%. The subjective success rate was 92. 1%. The PFDI and PFIQ were significantly improved after surgery (p<0. 001). Among those with the simultaneous complaint of SUI, 82% were cured without any additional procedure. Three patients (4. 6%) experienced vaginal mesh extrusion. Two patients (3. 1%) reported worsening of dyspareunia after surgery.

The four arms polypropylene mesh is an effective device for simultaneous correction of anterior vaginal wall prolapse and SUI with a low complication rate at a medium-term follow-up. The majority of the subgroup with concomitant SUI were cured without a second simultaneous procedure.

Korean journal of urology. 2015 Dec 10 [Epub]

Farzaneh Sharifiaghdas, Azar Daneshpajooh, Mahboubeh Mirzaei

Urology-Nephrology Research Center, Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. , Kerman University of Medical Sciences, Kerman, Iran. , Kerman University of Medical Sciences, Kerman, Iran.