[Tolerance of mesh reinforcement inserted through vaginal approach for the cure of genital prolapses. A 317 continuous case study].

OBJECTIVES

To give the results of a prosthetic technique in genital prolapse surgery using a polypropylene mesh and study the complications and their treatment, mainly sexual discomfort.

MATERIALS AND

METHODS

A prospective study conducted over a 48-month-period in 317 patients. Surgery included fixing of an anterio-posterior mesh to the tendinous arc at the front and to the levator ani at the rear, after vaginal hysterectomy (in 75% of the cases). In the event of previous surgery, a single anterior or posterior mesh was used (in 25% of the cases).

RESULTS

The functional results are good (no 3rd grade prolapse relapse in 93% of the cases). Prosthetic exposition occurred in 62 patients (19%) and did not need surgical treatment when asymptomatic (38 patients followed at least for one year in 29 cases). On the other hand, women with normal sexual function previous to surgery showed discomfort (dyspareunia) when complications occurred such as exposition (24%) and mesh retraction (3%). Thirty-eight new surgical procedures were necessary in these patients.

CONCLUSION

Dyspareunia may occur after use of prosthetic reinforcement. One must certainly hesitate to propose this type of surgical approach for sexually active women without comparison with other surgical techniques (such as laparoscopic sacropexy). On the other hand, the use of mesh in vaginal surgery for genital prolapse appears to be useful and safe in elderly women who have no more sexual activity.