ABSTRACT

Objectives:

Urogynecologists are constantly looking for simple, safe and durable methods to cure apical pelvic floor prolapse (APFP). We used a well-known surgical technique utilizing either anterior or posterior pelvic floor compartment synthetic mesh (Prolift®, Gynecare, Somerville, NJ, USA) to reinforce the pelvic floor in cases of A-PFP with high risk of recurrence. The aim of this study was to analyze and compare cure rates as well as peri and post-operative related complications.

Patients and methods:

Patients with advanced A-PFP and being at risk for recurrence were enrolled into the study and underwent either anterior or posterior mesh implantation, according with the surgeon’s decision. Previous Pelvic Organ Prolapse (POP) surgical reconstruction, first degree relative with significant pelvic floor fascial defect and poor pelvic supportive tissue were regarded as risk factors for A-PFP recurrence. Pre-operative demographic data, operative details immediate and long term postoperative follow-up data were prospectively collected for patients at the first post-operative month and year. Tele-interview was held at study conclusion by un-biased researchers who collected also the data from patient’s charts and analyzed it.

Results:

A total of 57 A-PFP patients were subjected to the mesh operation in an overnight setting, at a university or privat hospitals, between October 2006 and May 2008. Twenty seven had an anterior compartment mesh and 30 patients had a posterior compartment mesh. Colporrhaphies and anti-incontinence mid-urethral synthetic sling operations (TVT-SECUR or TVT-Obturator®, Gynecare, Somerville, NJ, USA) were added upon indications. Peri and early post-operative complications included one event of bladder outlet obstruction which was conservatively treated. The operation failed and repeated surgery was needed with 3 patients, two of them had an anterior and one posterior mesh implant One patient of each group presented with an opposite side pelvic floor prolapse and 3 had recurrent USI.

Conclusions:

The mesh A-PFP reconstruction anterior and posterior mesh operation carries a low complication rate and high cure rate. The current study supports the previously reported favourable therapeutic outcome of this procedure and shows that the anterior and posterior meshes are similar regarding out-come. Thus, is the surgeon who allows to choose the mesh to be used as he finds anatomically and surgically appropriate.