Delmas V, Haab F, Costa P
Service d'Urologie, Hôpital Bichat, 46 rue Henri-Huchard, 75018 Paris, France.
Prog Urol. 2009 Dec;19(13):1025-30. doi: 10.1016/j.purol.2009.10.013. Epub 2009 Nov 11.
The advantages of vaginal way in the treatment of cystocele are simplicity, rapidity, peritoneal security. Raphy is subject to recidive. The meshes replace the weak fascia in its role of hammock (Delancey) for the bladder. The mesh covers the central and lateral fascial defects. The procedure consists in a short vertical colpotomy, vesicovaginal dissection, uterine preservation (if uterus is not pathologic), no vaginal excision. The mesh can be spread without fixation, fixed or anchored by arms in the obturator foramen. The results show a significative improvement in the risk of redux cystocele. Complications become less frequent with the expertise and quality of new meshes. Implants are a new vaginal evolving surgery: it must be evaluated by experts and practiced by experienced in vaginal approach surgeons.
经阴道途径治疗膀胱膨出的优点是操作简单、迅速，且不涉及腹腔。缝合修补易复发。补片替代薄弱的筋膜，起到支撑膀胱的“吊床”（德兰西）作用。补片覆盖中央和外侧筋膜缺损处。手术包括短的垂直阴道切开术、膀胱阴道分离术、保留子宫（若子宫无病变），不进行阴道切除。补片可展开而不固定，或通过臂状物固定或锚定在闭孔内。结果显示，复发膀胱膨出的风险显著降低。随着新型补片技术和质量的提高，并发症变得不那么常见。补片植入是一种新的阴道手术方式：必须由专家评估，并由有阴道手术经验的外科医生实施。
