Site-specific prolapse surgery. II. Vaginal paravaginal repair augmented with either synthetic mesh or remodelling xenograft

Richard I. Reid*, Kehui Luo

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    7 Citations (Scopus)

    Abstract

    Introduction and hypothesis: This study aims to answer the question, "Does tissue augmentation improve the mechanical repair of displacement cystourethrocoele?" Methods: A retrospective cohort study comparing 108 bridging graft vaginal paravaginal repairs (89 tissue-inductive xenografts and 19 polypropylene mesh) to 59 native tissue historical controls was conducted. Main outcome measures were same-site prolapse recurrence and time to failure. Initial reliability was evaluated by chi-squared test, 10-year durability by Kaplan-Meier survival analysis and risk factors by Cox regression. Results: Late recurrence was 17.7% lower with augmentation (logrank test χ2=8. 4, p value=0.0038<0.05, adjusted regression analysis χ2=2.94;p value=0.0866 <0.10), implicating collagen degeneration in repair failure. Conclusions: Rebuilding the pubocervical septum, from arcus to arcus and pubic ramus to pericervical ring, satisfies the mechanical but not the metabolic hernia principles. Bridging grafts simplify technical repair (reducing prolapse persistence from 10.2% to 4.6%), and also rejuvenate adjacent connective tissue (reducing late recurrence from 22.6% to 4.9%).

    Original languageEnglish
    Pages (from-to)601-609
    Number of pages9
    JournalInternational Urogynecology Journal
    Volume22
    Issue number5
    DOIs
    Publication statusPublished - 2011

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