New cystocele repair technique may improve on shortcomings of mesh

A new technique for meshless cystocele repair could avoid the shortcomings seen with traditional mesh placement, say researchers from the UCLA School of Medicine.

"We used an aspect of traditional repair-mattress sutures-to plicate the defect. The novel part of this procedure is that we interlocked the sutures to create a supporting mesh. The idea is that it gives the same support as mesh without being as tightly interwoven," first author Ngoc-Bich Le, MD, told Urology Times.

Dr. Le, working with Shlomo Raz, MD, and co-authors, explained that she and her colleagues were driven to create this new technique by the complications associated with mesh, which she noted prompted an FDA warning in 2008.

"The problem is that about a third of the patients will have recurrence within four years of the surgery. We were seeing an increase in the number of patients with complications such as infections. Many were in chronic pain, which was hard to resolve. We were battling between the durability of the cure and its complications," she explained.

The solution is called CRISP, or Cystocele Repair using Interlocking Sutures of Polypropylene. Dr. Le presented the results of the procedure in 63 patients who received the suture technique between January 2009 and July 2010. At 2-year follow-up in most of the patients, only one presented with a complication; a ureteric obstruction treated endoscopically. Dr. Le said tying sutures prior to cystoscopy should prevent such complications.

Postoperative questionnaires show an improvement in quality of life scores from a mean of 3.6/6 to 2.0/6 (p=.0115), and vaginal bulge scores on the Pelvic Floor Distress Inventory–Short Form 20 improved from 1.9/4 to 0.11/4 (p=.002).

Dr. Le said the team will have a reasonably reliable idea of the true utility of the procedure when the patients have reached 5-year follow-up.