Résumé
Objectif
Rapporter les résultats anatomiques et fonctionnels d’une cure de cystocèle par voie vaginale en utilisant une prothèse libre de polypropylène.
Matériel et méthodes
C’est une étude descriptive rétrospective de 63 femmes ayant une cystocèle opérée entre 1999 et 2001. Les mèches de polypropylène ont été placées dans l’espace rétropubien et laissées sous la vessie. Les prothèses sont libres. Les résultats anatomiques et fonctionnels ont été recueillis par un médecin indépendant de l’équipe des chirurgiens.
Résultats
Cinquante-neuf patientes ont été suivies (93 % de suivi) avec une moyenne de suivi à 79 mois (± 11). Au dernier suivi, 45 femmes étaient anatomiquement traitées (76 %) [Ba < −1, POP-Q, ICS]. On a observé 13 (22 %) de stade 2 de cystocèle ayant récidivé, un de stade 3 et aucun de stade 4. Les érosions vaginales des prothèses ont été rapportées dans dix (6 %) cas. Six (10 %), deux (3 %) et deux (3 %) érosions de novo ont été diagnostiquées respectivement à un, quatre et six ans de suivi. Deux des 14 patientes ayant une activité sexuelle étaient dyspareuniantes (14 %) et associées avec une érosion vaginale de la prothèse. Le médecin examinateur a retrouvé 100 % de rétraction des prothèses. Les douleurs vaginales ont été retrouvées chez trois (4 %) des patientes, celles n’ayant aucune activité sexuelle. Dix patientes ont nécessité une réintervention pour érosion vaginale (16 %).
Conclusion
La cure de cystocèle par prothèse de polypropylène libre est associée à un faible taux de récurrence ayant nécessité une deuxième réintervention.
Abstract
Objective
To report the long-term (>5 years) anatomical and functional outcome of transvaginal cystocele repair using a tension-free polypropylene mesh.
Methods
This study is a descriptive case series of 63 women with cystocele, operated from 1999 to 2001. The polypropylene mesh was placed from the retropubic space to the interior part of the bladder in a tension-free manner. The assessment of functional and anatomical results was done by a physician who was not one of the surgeons.
Results
Fifty-nine patients returned for follow-up (93%) with a mean follow-up of 79 months (±11). At last the follow-up, 45 women were anatomically cured (76%) (Ba < −1, POP-Q, ICS). We observed 13 (22%) stage 2 cystocele recurrences, one stage 3 cystocele recurrence and no stage 4 cystocele recurrence. A vaginal extrusion of the mesh was reported in ten (16%) patients. Six (10%), 2 (3%) and 2 (3%) de novo vaginal exposition were, respectively, diagnosed at one, four and six years of follow up. Two out of 14 patients had dyspareunia during sexual intercourse (14%), associated with vaginal extrusion of the mesh. Physical examination showed 100% mesh shrinkage. Vaginal pain was noted in three (4%) patients, with no sexual activities. Ten patients have nee-ded re-intervention for symptomatic vaginal erosion (16%).
Conclusion
Polypropylene mesh in cystocele repair is associated with a low rate of re-intervention for cystocele recurrence at long-term follow-up.
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Letouzey, V., de Tayrac, R., Gervaise, A. et al. Étude de suivi entre cinq et neuf ans des prothèses sous-vésicales libres dans la chirurgie de la cystocèle. Pelv Perineol 6, 15–20 (2011). https://doi.org/10.1007/s11608-010-0316-z
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DOI: https://doi.org/10.1007/s11608-010-0316-z