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Objective To evaluate the risk of vascular injury during transobturator approach of cystocele repair. Design Dissection of the obturator area by perineal approach was performed after placement of mesh needles used for cystocele mesh repair. Setting Surgery school of Paris. Population or sample Twenty obturator regions in ten fresh female cadavers. Methods Transperineal dissection of the obturator area was conducted in ten fresh female anatomic subjects after inserting anterior Prolift® needles. Main outcome measures The vascular anatomy of the obturator region was mapped. Distances between needles and vascular structures of the obturator area were measured three times and averaged for each side. Results The anterior cannula-equipped needle perforated the gracilis and the adductor brevis muscles. The mean (SD) distance to the anterior obturator vessels was 21.2 (1.6) mm on the right side and 20.4 (1.5) mm on the left. The posterior needle perforated the adductor magnus. Its distance to the posterior division of the obturator vessels was 1.8 (1.0) mm on the right side and 1.1 (0.9) mm on the left. Conclusions During mesh cystocele repair by transobturator approach, the posterior obturator vessels division seems at risk of injury during the posterior needle insertion. [ABSTRACT FROM AUTHOR]

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Objective: To compare infracoccygeal sacropexy (IS) and sacrospinous suspension (SS) for the treatment of uterine or vault prolapse.Methods: A randomized trial of 49 women assigned to either the IS group using IVS tape (n=24) or SS group (n=25). Concomitant hysterectomy and repairs were performed as appropriate. Evaluations included prolapse staging using the POP-Q system and validated questionnaires for symptoms (PFDI), quality of life (PFIQ), and sexuality (PISQ-12). The primary outcome measure was postoperative pain.Results: Patients' characteristics were similar in both groups. IS was quicker, easier, and less painful than SS (P<0.01). Hemorrhage or hematoma rates were similar. Neither rectal injury nor vaginal erosion occurred. Mean follow-up was 16.8 months. Prolapse cure rates, symptom scores, and quality of life were similar. Postoperative cystocele occurred in 4.8% of women after IS and 25% after SS (P>0.05).Conclusion: Infracoccygeal sacropexy is equivalent to sacrospinous suspension, with a decreased rate of postoperative pain and cystocele recurrence. [ABSTRACT FROM AUTHOR]

Abstract: Many surgical procedures for the repair of pelvic organ prolapse are used nowadays. Reconstructive pelvic surgery continues to evolve while surgeons continue to search the definitive surgical cure and have to choose the most appropriate procedures for their patients. Concerning the vaginal approach procedures, there is an increasing interest in the use of synthetic meshes which are at present widely used for surgical repair of pelvic organ prolapse. Prosthetic repair seems to be more reliable, especially when native tissues are of poor quality. The use of synthetic meshes may also simplify surgical procedures and reduce operative duration and morbidity. Material must be inert, permanent and resistant to infection. Based on authors'' and other researchers'' published experimental and clinical experience, polypropylene is assumed to be the most appropriate material for the vaginal repair of pelvic organ prolapse. However, since no standardized outcome measure is available, it is difficult to compare the results of surgical procedures. Only in recent studies, the subjective cure rates (patient satisfaction and outcome) have been assessed as well as the objective cure rates determined by the investigators. The subjective cure rate is probably more influenced by the functional outcome and sexual activity than by the anatomical result. Continuous evaluation is necessary to study replacement synthetic materials which should improve the rate of prolapse recurrence and reduce the risk of complications. Randomized controlled trials are required to determine which surgical procedures and type of prosthesis are most suitable. This review evaluates the properties of prosthetic materials, their complications and the most common procedures involved in the use of meshes for pelvic reconstructive surgery. [Copyright &y& Elsevier]