[Cystocele repair with a polypropylene mesh: our experience].

Objectives: To evaluate the efficacy of the polypropilene mesh shaped in a T, with a circular area (to repair the cystocele) and an anterior extension (to function as a tension free sling), for the combined treatment of cystocele and urinary incontinence.

Methods: Retrospective study including 31 female patients with cystocele, with or without urinary incontinence, undergoing mesh repair. Mean age was 62.3 yr. (range 55-72). All patients were multiparous. Number of childbirths varied between 1 and 4. Mean follow-up was 23.5 months (range 12 to 29 months). 80% had grade III cystocele and 20% grade IV. 28 patients (90.3%) presented with urinary incontinence and 3 (9.67%) urgency without incontinence. 16 patients had previously undergone hysterectomy and another 6 surgery for urinary incontinence (2 Raz and 4 Burch operations). 11 patients (33.6%) needed a combination technique in the same operation: associated vaginal hysterectomy in 4 patients and posterior mesh colporrhaphy for grade III symptomatic rectocele in 7 patients.

Results: No patient had prolapse recurrence, 1 patient needed clean intermittent catheterizations for 3 months, and 3 suffered de novo urgency (with good response to anticolinergic drugs). The worsening of stress urinary incontinence (SUI) in one patient was solved by suburethral sling insertion; another patient who had prolonged postoperative vaginal bleeding requiring blood transfusions and subsequent mesh erosion of the vaginal wall (she underwent re-operation to cut off the mesh). 3 patients complained of intercourse discomfort which disappeared after an average of 3 months. No other remarkable intra or postoperative complications appeared.

Conclusions: The polypropilene mesh associated with a sling is an effective treatment to repair cystocele with or without SUI, although long-term studies with a greater number of patients are required to validate the technique.