Cystocele: Mesh, colporrhaphy yield similar results

Toronto-Recurrence of prolapse after anterior colporrhaphy is quite high-from 30% to 50%. Because mesh repair after recurrence is thought to be effective, shouldn't it be used in primary repair? A study from Dutch and Belgian researchers didn't come up with a positive answer.

Results were similar with anterior colporrhaphy and Perigee mesh repair (American Medical Systems, Minnetonka, MN), but early postoperative pain was higher with the mesh, and operative blood loss with mesh repair was significantly higher, said first author S.D. Thijs, MD, a PhD student at the Academic Medical Center in Amsterdam, the Netherlands, at the 2010 joint meeting of the International Continence Society and the International Urogynecological Association. Dr. Thijs worked on the study with Jan-Paul W.R. Roovers, MD, PhD, and colleagues.

The study included 96 patients at the Academic Medical Center and at University Hospital Gasthuisberg in Leuven, Belgium, who were randomized to treatment with either type of primary repair. Patients all had stage 2 or greater cystocele, with the anterior wall as the most descending compartment. If patients had concomitant apical compartment prolapse, vaginal hysterectomy or sacrospinous ligament fixation was performed. If patients had concomitant stress urinary incontinence, they also received a midurethral sling.

Similar numbers of patients in each group had concomitant apical and posterior compartment procedures, complications during surgery, and postoperative complications, although more patients (six) who underwent colporrhaphy had midurethral slings placed than patients who underwent mesh repair (one).

A year later, UDI and DDI were not significantly different between the groups. Although anatomic results concerning the anterior compartment were significantly better with the mesh at 6 months and 1 year after surgery, there were no significant differences in the apical and posterior compartment scores. In addition, there were no differences between the groups in terms of length of hospital stay and duration of catheterization.

More pain with mesh group

The mesh group, however, had significantly more pain in the first week (day 3-6) after surgery and significantly more blood loss when concomitant apical compartment repair was performed compared with the colporrhaphy group (100 mL vs. 60 mL).

Reinterventions-but different ones-were required in both groups. Among those who underwent primary anterior colporrhaphy, five patients needed midurethral slings, two needed anterior compartment repair again, and one needed correction for the apical and posterior compartment. In the mesh group, two patients needed midurethral slings, and four patients had mesh exposures that required surgical reintervention.

"We have not provided evidence of benefits for mesh use in primary repair of anterior compartment prolapse in the first 12 months after operation," Dr. Thijs concluded.