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Objectives: McCall culdoplasty is a commonly performed procedure for pelvic organ prolapse surgical repair; despite its good efficacy, however, anterior prolapse recurrence frequently occurs. The aim of our study was to verify whether fixation of utero-sacral ligaments (USLs) to anterior vaginal wall during a modified McCall culdoplasty (MMC) could reduce the rate of anterior recurrence of prolapse.Study Design: This was a retrospective study on women submitted to MMC after vaginal hysterectomy and anterior colporraphy for prolapse repair. Patients undergoing concurrent anterior fixation of USLs (AF) were compared to cases treated with MMC alone, evaluating potential differences in anatomic result of prolapse repair at 12 months, rate of anterior recurrence over time, operative data and post-operative morbidity.Results: Women undergoing MMC with AF (n = 45), compared with patients treated with MMC alone (n = 77), showed better results in terms of anatomic support in the anterior compartment at 12 months, assessed by means of POP-Q system parameters Aa (-1.8 cm vs -1.2 cm, p 0.0025) and Ba (-2.0 cm vs -1.3 cm, p 0.00015), and a lower rate of anterior recurrence (11.1% vs 29.9%, p 0.025); the other parameters of prolapse anatomic staging did not differ significantly, nor did operative data or post-operative morbidity. Follow up confirmed a longer disease-free survival over time for women treated with MMC with AF (p 0.028) CONCLUSIONS: Fixation of USLs to anterior vaginal wall at time of post-hysterectomy MMC appears to improve anatomic outcomes of the procedure reducing the risk of anterior prolapse, without implying a reduced safety, nor a greater surgical complexity. [ABSTRACT FROM AUTHOR]

Abstract Background Native tissue cystocele repair has been the cornerstone of prolapse surgery, especially since the learned societies warned clinicians and patients about serious mesh-related complications. Surgical techniques mainly consist in anterior colporraphy and vaginal patch plastron. However, success rates of native tissue cystocele repair are heterogeneous, depending on the design of studies and definition of outcomes. To date, high-quality data comparing vaginal native tissue procedures are still lacking. Methods Herein we aimed to describe the design of the first randomized controlled trial (TAPP) comparing anterior colporraphy (plication of the muscularis and adventitial layers of the vaginal wall) and vaginal patch plastron (bladder support anchored on the tendinous arch of the pelvic fascia by lateral sutures) techniques. Our aim is to assess the effectiveness of vaginal native tissue repair at 1 year for cystocele with a combined definition of success—anatomic and functional. The primary endpoint will be the success rate 1 year after surgery with a composite of objective and subjective measures (Aa and Ba points

Background: Native tissue cystocele repair has been the cornerstone of prolapse surgery, especially since the learned societies warned clinicians and patients about serious mesh-related complications. Surgical techniques mainly consist in anterior colporraphy and vaginal patch plastron. However, success rates of native tissue cystocele repair are heterogeneous, depending on the design of studies and definition of outcomes. To date, high-quality data comparing vaginal native tissue procedures are still lacking.Methods: Herein we aimed to describe the design of the first randomized controlled trial (TAPP) comparing anterior colporraphy (plication of the muscularis and adventitial layers of the vaginal wall) and vaginal patch plastron (bladder support anchored on the tendinous arch of the pelvic fascia by lateral sutures) techniques. Our aim is to assess the effectiveness of vaginal native tissue repair at 1 year for cystocele with a combined definition of success-anatomic and functional. The primary endpoint will be the success rate 1 year after surgery with a composite of objective and subjective measures (Aa and Ba points < 0 from POP-Q (Pelvic Organ Prolapse Quantification System) and a negative answer to question 3 of Pelvic Floor Distress Inventory and no need for additional treatment).Discussion: A prospective study has found a success rate at 35% for anterior colporraphy based on a combined definition, both anatomic and functional, as recently recommended. However, the definition of anatomic was strict (POP-Q< 2), while it seems that the best definition of anatomic success is "no prolapse among the hymen", that is to say Aa and Ba points from the POP-Q classification < 0. We hypothesize that vaginal patch plastron will have a better anatomic and functional success comparatively to anterior colporraphy because native tissue is added, as it corrects both median and lateral cystoceles thanks to bilateral paravaginal suspension.Trial Registration: CHU LIMOGES is the sponsor of this research (n°87RI18_0013). This research is supported by the French Department of Health (PHRC 2018-A03476-49) and will be conducted with the support of DGOS (PHRC interregional - GIRCI SOHO). The study protocol was approved by the Human Subjects Protection Review Board (Comité de Protection des Personnes) on May 16, 2019. The trial is registered in the ClinicalTrials.gov registry ( NCT03875989 ). [ABSTRACT FROM AUTHOR]

Introduction: Pelvic floor hernias are encountered especially in elderly women. A combined genital, bladder, and rectal prolapse poses treatment challenges in aged women.

Objective. To assess the effectiveness of the polypropylene tape in preventing cystocele recurrence. Methods. Fifty Caucasian women aged 50-77 years (mean age 66.6 years), with stage II-IV pelvic organ prolapse, enrolled into the study. Vaginal reconstructive surgery included an anterior colporrhaphy on all patients, posterior colpoperineorrhaphy on 28 patients and hysterectomy on 36 patients. Patients were divided into a study group of 28 women and a control group of 22 women. As reinforcement to the anterior colporrhaphy procedure, in the study group a polypropylene tape (TVT-O) was placed underneath the bladder base and fixed with polyglactin sutures. Postoperative follow-up was carried out every 4 months (total 48 months). The assessment of the anatomic result included both clinical evaluation of the operated sites and perineal sonography. Results. The mean postoperative distance of the bladder base to the inferior edge of the symphysis pubis was 1.5 cm (range: 1.0-2.2 cm) in the study group and 2.8 cm (range: 2.0-3.8) in the control group. Postoperatively, there were two cases of stress incontinence and two cases of urge incontinence, one in each group. No case of tape erosion was noted, no dyspareunia and no recurrent cystocele in the study group. Four cases of recurrent cystocele (20%) were reported in the control group. Conclusion. While the preliminary results of our study are encouraging, larger series of patients and longer follow-up are required to verify the effectiveness of the aforementioned modification. [ABSTRACT FROM AUTHOR]

Abstract Objective: The objective was to evaluate in a homogeneous series of patients the clinical and urodynamics outcomes following anterior colporrhaphy and approximation of pubococcygeus muscles for correcting cystocele and genuine stress incontinence (SUI). Methods: The authors analyzed the pre- and postoperative clinical and urodynamics data of 56 consecutive, not previously operated, patients underwent anterior colporrhaphy and approximation of pubococcygeus muscles by the same surgeon. The mean follow-up period was 20 months (range 12-32). Statistical analysis was performed with Wilcoxon matched pairs test and Fisher's exact test. Results: Four (8%) patients experienced cystocele recurrence at a lesser degree than pre operatively and 2 (4%) patients developed grade II rectocele postoperatively. Recurrence of cystocele occurred only among those patients undergone sacrospinous colposuspension (4 out of 20 vs. 0 out of 32, P=0.018). Manifested and potential genuine stress incontinence (Pot-SUI) treatment was successful in 18 out of 30 (60%) patients. These patients showed a significant increase (P<0.001) of bladder-to-urethra pressure transmission ratio (PTR) values whereas, in those patients who presented recurrence, such an increase did not occur. Conclusion: Anterior colporrhaphy and approximation of pubococcygeus muscles appears, from our preliminary results to be a safe, effective technique for the primary treatment of cystocele without compromising the other vaginal profiles but should not be considered as the procedure of choice for patients presenting with manifested or Pot-SUI. Long-term follow-up is needed to evaluate whether these results are durable. Keywords [ABSTRACT FROM AUTHOR]