Department of Urogynecology, S. Carlo-IDI Hospital, Via Aurelia 275, 00165 Rome, RM, Italy.
Eur J Obstet Gynecol Reprod Biol. 2011 Jun;156(2):223-7. doi: 10.1016/j.ejogrb.2011.01.027. Epub 2011 Mar 1.
We evaluated the efficacy and safety of a collagen-coated polypropylene mesh with a trans-obturator approach for cystocele repair.
We considered as eligible for our study 97 patients with a stage ≥ 2 cystocele according to the Pelvic Organ Prolapse Staging System (POP-Q), with or without associated apical or posterior vaginal wall prolapse. They were also evaluated pre- and post-operatively using validated questionnaires (P-QoL, Wexner and PISQ-12). Patients underwent cystocele repair using Avaulta Biosynthetic Anterior Support System (CR Bard Inc., Billerica, USA). Objective anatomical cure was defined when points Ba, C and Bp were at stage 0 (good outcome) or stage 1 (satisfactory outcome). The McNemar chi-square test was used to compare categorical variables, the paired t-test for continuous parametric variables, and the Mann-Whitney test for continuous non-parametric variables.
All patients completed the 1-year follow-up. We observed an anatomical cure rate of 64.9% for anterior vaginal wall prolapse (point Ba<-1), and a statistically significant improvement in storage, voiding, post-micturition and prolapse-related symptoms. Quality of Life and sexuality were also statistically improved, while we found no impact on anorectal function. We also observed the development of vaginal mesh exposure in 21 patients (21.6%).
Our data suggest that the collagen-coated polypropylene mesh, as we used it, gives a high recurrence rate (35.1%) and a high exposure rate (21.6%) at one-year follow-up, and is consequently unsatisfactory for the treatment of anterior vaginal wall prolapse.
我们评估了经闭孔途径的胶原蛋白涂层聚丙烯网片在治疗膀胱膨出中的疗效和安全性。
我们将符合盆腔器官脱垂分期系统（POP-Q）的 97 例 2 度及以上膀胱膨出患者（伴或不伴阴道顶或后壁脱垂）纳入研究。在术前和术后使用经过验证的问卷（P-QoL、Wexner 和 PISQ-12）对患者进行评估。患者采用 Avaulta 生物合成前支撑系统（CR Bard Inc.，Billerica，美国）进行膀胱膨出修复。当 Ba、C 和 Bp 点处于 0 期（良好结局）或 1 期（满意结局）时，定义为客观解剖学治愈。采用 McNemar 卡方检验比较分类变量，配对 t 检验比较连续参数变量，Mann-Whitney 检验比较连续非参数变量。
所有患者均完成 1 年随访。我们观察到阴道前壁膨出（Ba 点<-1）的解剖学治愈率为 64.9%，并观察到存储、排尿、排尿后和脱垂相关症状显著改善。生活质量和性生活也得到了统计学上的改善，而肛门直肠功能没有受到影响。我们还观察到 21 例患者（21.6%）发生阴道网片暴露。
我们的数据表明，在 1 年随访时，我们使用的胶原蛋白涂层聚丙烯网片复发率高（35.1%），暴露率高（21.6%），因此对于阴道前壁膨出的治疗效果不理想。
