Adhoute Frédéric, Soyeur Luc, Pariente Jean-Louis, Le Guillou Michel, Ferriere Jean-Marie
Service d'Urologie, CHU Pellegrin-Tripode, 33076 Bordeaux.
Prog Urol. 2004 Apr;14(2):192-6.
To evaluate the efficacy and safety of strict transvaginal implantation of a non-resorbable synthetic prosthesis (Gynemesh) for the treatment of female genital prolapse.
The anatomical and functional results of 52 women operated between September 1999 and December 2002 were evaluated prospectively. The mean age of the patients was 62 years. All patients presented a cystocele, associated with a hysterocele, an elytrocele or a rectocele in 28%, 9.5% and 38% of cases, respectively. Urinary incontinence was reported in 65% of patients, and 30% of women had a history of previous pelvic surgery. Depending on the components of the prolapse, the operation comprised anterior or posterior mesh implantation, hysterectomy and TVT insertion. Patients were reviewed by a different surgeon from the operator at 3 months, 6 months and then annually.
With a mean follow-up of 27 months, the anatomical success rate was 95% for correction of cystocele, and 100% for correction of rectocele. Vaginal erosion by the mesh occurred in two cases after cystocele repair (3.8%).
Transvaginal implantation of a polypropylene prosthesis is a safe and reproducible technique, which is effective in the medium term for the treatment of prolapse, but further studies are required to confirm this technique as a valid alternative to existing techniques.
评估不可吸收合成假体（Gynemesh）经阴道严格植入治疗女性生殖器脱垂的疗效和安全性。
前瞻性评估1999年9月至2002年12月间接受手术的52例女性的解剖学和功能结果。患者平均年龄为62岁。所有患者均有膀胱膨出，分别有28%、9.5%和38%的病例合并子宫膨出、阴道膨出或直肠膨出。65%的患者报告有尿失禁，30%的女性有既往盆腔手术史。根据脱垂的组成部分，手术包括前路或后路网片植入、子宫切除术和经阴道无张力尿道中段吊带术（TVT）插入。术后3个月、6个月由与手术医生不同的外科医生进行复查，之后每年复查一次。
平均随访27个月，膀胱膨出矫正的解剖学成功率为95%，直肠膨出矫正的成功率为100%。膀胱膨出修复后有2例（3.8%）出现网片侵蚀阴道的情况。
经阴道植入聚丙烯假体是一种安全且可重复的技术，中期治疗脱垂有效，但需要进一步研究以证实该技术可作为现有技术的有效替代方法。
