Transobturator four-arms mesh in the surgical management of cystocele: a long-term follow-up

Abstract

We studied the long-term efficacy and safety of cystocele operation by polypropylene mesh. A total of 198 women with stage ≥ 2 cystocele who had anterior vaginal wall repair with transobturator fourarm polypropylene mesh during 2003 to 2015 were evaluated. Outcomes including clinical characteristics and complications were reviewed by extracting patient data from electronic medical records. In addition, telephone in-terviews were conducted using a validated questionnaire along with physical examination. The follow-up period was 9.3 ± 0.3 years. The cystocele stage in patients was significantly decreased post-operation compared to that preoperation. The anatomical cure rate for cystocele was 93.4%, and that for stress urinary incontinence was 95%. Compar-ing the three questionnaires indicated overall average score was im-proved significantly, except for Female Sexual Function Index Assess-ment. Early complications were either resolved spontaneously or con-trolled medically in four cases of hematoma or abscess, three cases of vaginal infection and urinary tract infection, and four cases of difficult micturition. In late complications, four cases of pain were managed, five cases of recurrence were observed and two cases of mesh exposure were treated with ointment and local excision. Transobturator four-arms mesh is an effective and safe method for cystocele repair with low rate of recurrence and complications. We suggest that the use of transobtu-rator four-arm mesh is a still good choice for the old patients with cysto-cele who are not suitable for general anesthesia and reside in areas where laparoscopy and robots are not available