A NEW OPERATION FOR GENITOURINARY PROLAPSE

Abstract

A new method to support female prolapsed pelvic organs is presented, which involves use of nonabsorbable mesh cut in a hammock shape. The approach is transvaginal and the novelties are the way in which the mesh is anchored and its considerable size.The mesh is anchored transversally between the 2 arcus tendineus of the endopelvic fascia and in the anteroposterior direction between the bladder and uterine necks. The anteroposterior dimension of the mesh must completely cover the cystocele. From January 1996 to June 1997 this technique was used in 44 patients ranging in age from 43 to 86 years. The patients presented with various degrees of incontinence and combinations of cystocele, uterine or vaginal vault prolapse, rectocele and/or enterocele. Cystocele and incontinence were classified according to the SEAPI QMM scales and the other anatomical defects according to the Beecham classification. Preoperative analysis of all patients included cystography, video urodynamics, and pelvic and abdominal echography.All patients affected by some degree of incontinence were cured. Patients with prolapse without incontinence were completely satisfied with the operation. Uterine prolapse was third degree in 6 of 20 patients and it partially recurred in 3. Cystography in all patients demonstrated excellent repair of the descensus. Sexual life and menses did not change, and no pelvic fibrosis or hydroureteronephrosis occurred. Followup ranges from 9 to 23 months (median 13.9).This technique has broad application and is simple to perform. Longer followup will prove its merits definitively.