Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt.
Arch Gynecol Obstet. 2012 Oct;286(4):965-72. doi: 10.1007/s00404-012-2383-6. Epub 2012 May 31.
To compare the clinical effectiveness of anterior colporrhaphy versus mesh repair as surgical management of anterior vaginal prolapse.
Of 50 patients with ≥stage II anterior vaginal prolapse on Pelvic Organ Prolapse Quantification (POPQ) system who were initially approached, 44 consented and underwent surgery. They were randomly recruited into two groups. Group I (23 patients) received anterior colporrhaphy, while group II (21 patients) received soft polypropylene mesh (GYNEMESH*PS, Gynecare, Ethicon, France). Clinical assessment took place preoperatively and postoperatively at definite intervals. Functional and anatomical comparisons were based on comparison between preoperative and 24 months postoperative assessments of symptoms and POPQ stages, respectively. Four patients in total did not complete the follow-up assessments and were excluded.
Both groups showed clinical improvement in their symptoms and POPQ staging at the end of the postoperative follow-up period. Improvement, however, was more significant in the repair with mesh group, as patients in this group reported better improvement of their prolapse symptoms, mainly vaginal bulge/pressure sensation (P < 0.05), and showed better improvement in the anatomical staging, individual POP-Q points Aa and Ba (P < 0.01), than the anterior colporrhaphy group. Group II also showed more satisfactory outcome with the general POP-Q staging (P < 0.05) than group I, reflecting a better quality of life of the patients in the repair with mesh group.
Our data shows that repair with mesh is superior to anterior colporrhaphy with more satisfactory outcome to the patients. Due to the small size of our study and uncertainty of the long-term safety and resilience of the mesh, we recommend larger studies to confirm our preliminary results.
比较经阴道前壁修补术与网片修补术治疗阴道前壁膨出的临床疗效。
50 例阴道前壁脱垂患者（POP-Q 系统分期≥Ⅱ期），其中 44 例患者同意并接受手术治疗。他们被随机分为两组：组 I（23 例）行经阴道前壁修补术，组 II（21 例）行软聚丙烯网片修补术（GYNEMESH*PS，Gynecare，Ethicon，法国）。术前及术后一定时间进行临床评估。功能和解剖学比较基于术前和术后 24 个月症状和 POP-Q 分期的比较。共有 4 例患者未完成随访评估，被排除在外。
两组患者在术后随访期末的症状和 POP-Q 分期均有临床改善。然而，网片修补组的改善更为显著，患者报告阴道膨出/压迫感明显改善（P<0.05），POP-Q 点 Aa 和 Ba 的解剖学分期也有明显改善（P<0.01），优于经阴道前壁修补术组。组 II 的一般 POP-Q 分期也显示出更满意的结果（P<0.05），表明网片修补组患者的生活质量更好。
我们的数据表明，网片修补术优于经阴道前壁修补术，患者的结局更满意。由于我们的研究规模较小，网片的长期安全性和耐用性不确定，我们建议进行更大规模的研究以证实我们的初步结果。
