Urogenital prolapse--current methods of surgical treatment.

UNLABELLED: Several combined surgical procedures have been described, but connective tissue deficiency required the use of some "prostheses" instead of conventional methods based exclusively on correction by suture.

AIM: Assessment of the techniques used for the repair of stress urinary incontinence (SUI) and anterior vaginal wall prolapse, as well as the incidence of intraoperative and postoperative incidents and complications.

MATERIAL AND METHOD: The study was conducted between January 2007 and December 2011 at the 1st Clinic of Obstetrics and Gynecology Iaşi. The diagnosis was made on clinical criteria. Menopausal patients received estrogens prior to surgery. Vaginal meshes were used only in patients with grade III and IV cystocele. The patients were followed up at 1 1/2, 6, 12 and 36 months (first local evaluation for meshes at 2 weeks after surgery).

RESULTS

During the study interval 400 patient with a mean age of 57.45 ± 5 years (range 29-81 years) were surgically treated in our clinic. Of these, 150 women underwent classic surgery, 243 women transobturator tape procedure-TOT (107 TOT alone for SUI and 136 TOT combined with classic surgery), 4 women ten- sion-free vaginal tape (TVT) procedure, and 3 patients prepubic and transobturator mesh. In 12 patients meshes with 2 or 4 arms for cystocele (7 and 5 cases, respectively) were used. Vaginal mesh extrusion was recorded in 4 patients.

CONCLUSIONS

The use of prostheses allows a better standardization of procedures, shortening of surgical time and a better postoperative recovery, the patients being able to resume their normal activities.