Fascial sling supplementing anterior colporrhaphy for high grade cystocoele
Dr Danielle Taylor (1), Mr Henry Han-I Yao (1), Professor Helen E. O'Connell (1)
(1) Western Health, Melbourne, Australia
Pelvic organ prolapse is a common problem that affects women across the globe1,2. Surgical management for patients with high-grade cystocoele includes anterior colporrhaphy with or without concurrent reinforcement with grafts or mesh1,2. With increasing reports of significant complication relating to the use of mesh in pelvic organ prolapse surgery, allograft reinforcement appears to be an ideal alternative3. We report on our single surgeon experience of anterior colporrhaphy with pubovaginal sling as reinforcement for treatment of high-grade cystocoele.
From May 2008 to Nov 2017, all patients who had concurrent anterior colporrhaphy and pubovaginal fascial sling performed by the senior author of this article were included. Clinicopathological data were retrospectively collected from electronic medical records. Primary outcomes of this study were patient global impression of improvement (PGI-I) scores and patient reported outcomes of clinical symptoms at most recent questionnaire follow-up.
A total of 51 patients who had undergone concurrent anterior colporrhaphy and pubovaginal fascial sling for treatment of high-grade cystocoele during the study period returned follow-up questionnaires. The median age at time of surgery was 63 (IQR 56-70). Median follow-up was 69.7 months for both PGI-I scores and patient reported outcomes. PGI-I scores on follow-up demonstrated that 66.7% of patients reported improvement in prolapse symptoms. The median PGI-I score was 2. 74.5% of patient reported no vaginal bulge symptoms from cystocoele at the most recent follow-up, 19.6% had bulge symptoms from cystocoele but reported no bulge beyond the vaginal introitus, and 5.9% of patients had bulge from prolapse that extended beyond the vaginal introitus.
Anterior colporrhaphy with concurrent pubovaginal sling reinforcement for treatment of high-grade cystocoele has a sustained efficacy on patient reported outcomes, at a median follow-up of 69.7 months.