Grade 4 cystocele repair using four-defect repair and porcine xenograft acellular matrix (Pelvicol): outcome measures using SEAPI.

OBJECTIVES

To determine the efficacy of grade 4 cystocele repair using the four-defect repair (FDR) or modified FDR with porcine xenograft matrix (FDR+Pelvicol).

METHODS

During a 4-year period, 45 women underwent grade 4 cystocele repair. Of the 45 patients, 43 (95.5%) were available for follow-up. The mean age was 65 years. Patients presented with the following problems: grade 4 cystocele in 43 (100.0%), stress urinary incontinence in 24 (55.8%), urge urinary incontinence in 26 (60.4%), and obstructive voiding symptoms in 26 (60.4%). Patients were evaluated using the stress, emptying, anatomic, protection, and instability (SEAPI) test. We performed FDR in the first consecutive 24 (55.8%) and FDR+Pelvicol in the remaining 19 (44.2%) patients. Cystocele repair was accompanied by other transvaginal repair in 38 (88.3%) of the 43 patients.

RESULTS

The mean follow-up time was 15 months. A comparison of the preoperative and postoperative SEAPI scores of 0, representing the absence of complaints, revealed a statistically significant improvement in all the SEAPI domains using McNemar's test. Cystocele recurred in 3 patients (6.9%), all in the Pelvicol subgroup. Two patients (4.7%) had postoperative urinary retention. De novo urge incontinence occurred in 2 patients (11.7%). No infection, erosion, fistula, or vaginal stenosis have been reported.

CONCLUSIONS

Grade 4 cystocele repair using FDR or FDR+Pelvicol are two effective methods of cystocele repair. Although cystocele failures occurred exclusively in the Pelvicol+FDR subgroup, their small number and asymptomatic presentation did not result in statistical or clinical significance at this point. Both techniques are simple, efficacious, and well tolerated by patients. Follow-up is ongoing to evaluate the durability of the techniques.