Cystocele Repair by Autologous Rectus Fascia Graft: the Pubovaginal Cystocele Sling.

Abstract

PURPOSE:

The autologous rectus fascia pubovaginal sling has been a safe and effective means of correcting stress urinary incontinence. We tested the feasibility of using a larger graft to correct cystocele with or without stress urinary incontinence.

MATERIALS AND METHODS:

Between January 2006 and October 2010, 30 patients with symptomatic cystocele underwent the pubovaginal cystocele sling procedure, including 14 with and 16 without concomitant stress urinary incontinence. The technique is a modification of the standard pubovaginal sling procedure. A large trapezoidal (major base 6 cm, minor base 4 cm and height 5 cm) rectus fascia graft is used with 4 instead of 2 sutures to suspend the graft corners. The 2 sutures at the level of the mid urethra are tied above the rectus muscles in a tension-free manner while the 2 sutures at the level of the cervical fold are tied with tension. Data on anatomical outcomes (Baden-Walker classification), functional outcomes (PFIQ-7), post-void residual urine volume and urinary tract infection were prospectively collected.

RESULTS:

At a mean followup of 62.6 months (range 46 to 98) there was no recurrence in the anterior compartment. There was 1 recurrence involving the apical and posterior compartments. All patients reported a statistically significant improvement in PFIQ-7 score. When present preoperatively, post-void residual urine volume, urinary tract infection and stress urinary incontinence ceased in all cases. The only complication was donor site wound dehiscence without fascial involvement.

CONCLUSIONS:

The autologous pubovaginal cystocele sling seems to be a safe, effective technique to correct cystocele with or without stress urinary incontinence.

• Authors: Luigi Cormio, Vito Mancini, Giuseppe Liuzzi, Giuseppe Lucarelli, Giuseppe Carrieri
• Journal: The Journal of urology (J Urol) Vol. 194 Issue 3 Pg. 721-7 (Sep 2015) ISSN: 1527-3792 [Electronic] United States
• PMID: 25837536 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Topics

• Autografts
• Cystocele (complications, surgery)
• Fascia (transplantation)
• Feasibility Studies
• Female
• Humans
• Middle Aged
• Prospective Studies
• Rectus Abdominis
• Suburethral Slings
• Urinary Incontinence, Stress (complications, surgery)