Vol. 43 (3): 525-532, May – June, 2017
Luis Gustavo M. de Toledo 1,2, André Costa-Matos 2, Susane Mey Hwang 2, Raquel Dória Ramos Richetti 2, Silvia S. Carramão 1, Antônio P. F. Auge 1
1 Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil; 2 Serviço de Uroginecologia, Maternidade Cachoeirinha, São Paulo, SP, Brasil
Introduction: In high stage vaginal prolapse, recurrence risk patients, anterior and apical defects need to be addressed in the same procedure. The pre-molded commercial mesh kits are expensive and not always available. Alternative effective and safe treatment ways, with lower costs are desirable.
Objective: To present long term follow-up of patients treated with a homemade mesh shape to correct high stage prolapses.
Materials and Methods: We describe prospectively 18 patients with anterior and apical vaginal prolapses, stages III and IV, repaired using this specific design of mesh. All patients were submitted to pre-operative clinical evaluation and urodynamics. Prolapse was classified using the pelvic organ prolapse quantification (POP-Q). Intervention: Prolapse surgery, using a six arms prolene mesh, through a single anterior vaginal incision.
Outcome Measurements: POP-Q, patients satisfaction, descriptive statistical analysis.
Results: Between February 2009 and Oct 2010, 18 consecutive women underwent the above-mentioned surgery. Mean age was 68 years. At a mean follow-up of .,4 years (5 to 5.8 years), 16 (89%) patients were continent, mean Ba point came from +4.7cm to – 2.5cm, mean C point from +2.8cm to -6.6cm and mean Bp point from +1.3 to -1.7cm.
There were two (11%) objective failures, but all the patients were considered success subjectively. There were two cases of mesh vaginal extrusion.
Conclusions: The homemade six arms prolene mesh allows concomitant correction of anterior and apical prolapses, through a single anterior vaginal incision, being an effective, safe and affordable treatment option when mesh is needed.
Keywords: Surgical Mesh; Pelvic Organ Prolapse; Surgical Procedures, Operative