Handel LiAnn N, Frenkl Tara L, Kim Young H
Rhode Island Hospital, Brown University, Providence, Rhode Island, and Merck and Co., Inc., Rahway, New Jersey, USA.
J Urol. 2007 Jul;178(1):153-6; discussion 156. doi: 10.1016/j.juro.2007.03.041. Epub 2007 May 17.
Because traditional anterior colporrhaphy can have a high recurrence rate, we assessed the recurrence rate of 3 methods of cystocele repair, including 1) traditional anterior colporrhaphy, 2) repair using porcine dermis interposition graft and 3) repair using polypropylene mesh. Additionally, we compared the rate of erosion of porcine dermal graft with that of polypropylene mesh.
The records of patients who underwent cystocele repair by the same urologist using porcine dermal graft, polypropylene mesh or traditional repair from January 1999 to August 2005 were reviewed. Data were collected on history, physical examination, outcomes and complications. Using the Baden-Walker system a cystocele of grade 2 or higher on followup examination was considered recurrence.
A total of 119 patients underwent cystocele repair from January 1999 to August 2005. Followup was available on 99 patients and it averaged 13.5 months (range 2 to 46). Of the patients 56 (57%) underwent cystocele repair using porcine dermal graft, 25 (25%) received polypropylene mesh and 18 (18%) underwent traditional repair. Of the 99 patients 22 (22%) had cystocele recurrence. Based on the type of repair 36% of patients (20 of 56) with porcine dermal grafts had recurrence compared to 4% (1 of 25) and 6% (1 of 18) using polypropylene and traditional repair, respectively. Mean time to cystocele recurrence was 4.9 months (range 0.5 to 20). A total of 12 patients (21%) had extrusion of porcine grafts through the anterior vaginal wall incision compared to 1 (4%) with polypropylene mesh.
In our patient population the short-term failure rate for anterior vaginal wall prolapse using porcine dermis interposition graft was higher than that for traditional anterior colporrhaphy or polypropylene mesh. In addition, the incidence of vaginal extrusion of porcine graft was unacceptably high. Porcine dermis is a less suitable material for cystocele repair than polypropylene mesh or traditional anterior colporrhaphy. Prospective, randomized trials are necessary to determine the true efficacy and complication rates of these graft materials for anterior vaginal wall prolapse repair.
由于传统的前壁修补术复发率较高，我们评估了3种膀胱膨出修补方法的复发率，包括1）传统的前壁修补术、2）使用猪真皮植入物修补和3）使用聚丙烯网片修补。此外，我们比较了猪真皮植入物与聚丙烯网片的侵蚀率。
回顾了1999年1月至2005年8月间由同一位泌尿科医生使用猪真皮植入物、聚丙烯网片或传统修补方法进行膀胱膨出修补的患者记录。收集了病史、体格检查、结果和并发症的数据。使用巴登-沃克系统，随访检查时2级或更高等级的膀胱膨出被视为复发。
1999年1月至2005年8月共有119例患者接受了膀胱膨出修补术。99例患者获得随访，平均随访时间为13.5个月（范围2至46个月）。其中56例（57%）患者使用猪真皮植入物进行膀胱膨出修补，25例（25%）接受聚丙烯网片修补，18例（18%）接受传统修补。99例患者中有22例（22%）出现膀胱膨出复发。根据修补类型，使用猪真皮植入物的患者中有36%（56例中的20例）复发，而使用聚丙烯网片和传统修补的分别为4%（25例中的1例）和6%（18例中的1例）。膀胱膨出复发的平均时间为4.9个月（范围0.5至20个月）。共有12例患者（21%）的猪植入物通过阴道前壁切口挤出，而使用聚丙烯网片的为1例（4%）。
在我们的患者群体中，使用猪真皮植入物进行阴道前壁脱垂的短期失败率高于传统的前壁修补术或聚丙烯网片。此外，猪植入物阴道挤出的发生率高得令人无法接受。与聚丙烯网片或传统的前壁修补术相比，猪真皮是一种不太适合用于膀胱膨出修补的材料。需要进行前瞻性随机试验来确定这些植入材料用于阴道前壁脱垂修补的真正疗效和并发症发生率。
