ANTERIOR VAGINAL REPAIR: A COMPARISON AMONG COLPORRAPHY, BIOMESH, AND MESH

NTRODUCTION AND AIM OF THE STUDY The aim of our study was to assess the long-term efficacy, subjective and objective outcomes, and complications in patients treated for pelvic organ prolapse (POP) with transvaginal anterior colporraphy alone, with transvaginal anterior colporraphy associated with the use of a non-synthetic porcine skin biomesh graft (Pelvisoft® Biomesh), and with transvaginal anterior repair with the use of a polypropylene mesh (TAM). MATERIALS AND METHODS A retrospective study was performed at a single centre. Forthy-seven women aged 46–80 years underwent cystocele repair: 17 underwent a transvaginal anterior colporraphy alone (TAC), 15 with an associated Pelvisoft® graft implant (TACP), and 15 had an anterior repair with a mesh. Mean follow-up was 80.3 months (range 8–132 months). Table 1 shows patients data. Subjectives outcomes have been evaluated by Patient Global Impression of Improvement (PGI-I) and Patient Perception of Bladder Condition (PPBC) − Italian. Objective outcome have been evaluated for each patient by two different surgeons and we considered a failure an aterior vaginal wall recurrence ≥2° POP-Q. RESULTS results are listed in table 2. In TAC group subjective unsatisfied patients were 2/17 (11.7%); in TACP group subjective unsatisfied patients were 1/15 (6.6%); in TAM group subjective unsatisfied patients were 3/15 (20%). In TAC group the only complication was vaginal pain; in TACP group there was a bio-mesh extrusion and a pelvic hematoma; in TAM group there was a temporary urinary retention, 1 hematoma, and 3 extrusion. INTERPRETATION OF RESULTS Our data show a higher success and complication rate when a polypropylene mesh was used. In this group the elevate rate of complications was the cause of a higher dissatisfaction rate. Transvaginal anterior colporraphy alone, or associated with a Pelvisoft® bio-mash, had a high success rate with low complications, and an elevated satisfaction grade. CONCLUSIONS Considering the recent FDA order to reclassify surgical mesh from class II to class III (1), and the recent SCENHIR document on “Safety of surgical meshes used in urogynecological surgery” (2) our data show that it is possible to revalue transvaginal anterior colporraphy technique alone or associated with a bio-mash.