Skip to main content

Advertisement

SpringerLink
Log in

Solvent-dehydrated dermal allograft (AXIS™) augmented cystocele repair: longitudinal results

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

Surgical repair options for pelvic organ prolapse (POP) include native tissue, allograft, xenograft, and synthetic grafts. Solvent-dehydrated dermal allograft (SDDG) has an improved safety profile. We evaluated the long-term safety and efficacy of SDDG use for cystocele repair.

Methods

A total of 184 patients completed a minimum follow-up of 12 months. Incontinence Impact Questionnaire (IIQ), Urogenital Distress Inventory (UDI), and Visual Analogue Scale (VAS) were used pre and post operatively. Recurrent cystocele grade ≥ II and/or repeat cystocele repair were considered objective failure.

Results

Preoperatively, 17 patients (10%) had grade IV cystocele, 87 (47%) grade III, 70 (38%) grade II, and 10 (5%) grade I. All patients underwent SDDG cystocele repair with/without vaginal sling and/or POP repair and/or hysterectomy. Mean hospital stay was 0.58 days (range 0–4), mean estimated blood loss (EBL) was 111 mL, and mean length of Foley catheterization was 1.85 days (range 0–28). Postoperatively, 113 patients (64%) had no recurrent cystocele, 34 (19%) had grade I, 19 (11%) grade II, and 10 (6%) grade III cystocele. None had grade IV cystocele. Nineteen patients (10.3%) underwent repeat cystocele repair. Thirty-eight patients (21.6%) had postoperative recurrence (recurrent cystocele grade ≥ II and/or repeat cystocele repair). Dermal allograft related adverse events included 1 (0.5%) allograft vaginal exposure, dyspareunia 1 (0.5%), and transient hydronephrosis in 1 (0.5%). There were no vascular, vesical, visceral or neurological injuries.

Conclusions

These results indicate that SDDG augmented cystocele repair is a safe procedure, with low morbidity, and it’s success is comparable to other techniques.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

IIQ:

Incontinence Impact Questionnaire

PPD:

Pad per day

QoL:

Quality-of-life questionnaires

SDDG:

Solvent-dehydrated dermal allograft

SUI:

Stress incontinence

UDI:

Urogenital Distress Inventory

UUI:

Urge incontinence

VAS:

Visual Analog Scale

References

  1. Choe JM, Kothandapani R, James L, Bowling D. Autologous, cadaveric, and synthetic materials used in sling surgery: comparative biomechanical analysis. Urology. 2001;58:482–6.

    Article  CAS  PubMed  Google Scholar 

  2. Lemer ML, Chaikin DC, Blaivas JG. Tissue strength analysis of autologous and cadaveric allografts for the pubovaginal sling. Neurourol Urodyn. 1999;18:497–503.

    Article  CAS  PubMed  Google Scholar 

  3. Dmochowski RR, Blaivas JM, Gormley EA, Juma S, Karram MM, et al. Update of AUA guideline on the surgical management of female stress urinary incontinence. J Urol. 2010;183(5):1906–14.

    Article  PubMed  Google Scholar 

  4. Baden WF, Walker T. Fundamentals, symptoms, and classification. In: Baden WF, Walker T, editors. Surgical repair of vaginal defects. Philadelphia: Lippincott; 1992. p. 9–23.

    Google Scholar 

  5. De Tayrac R, Sentilhes L. Complications of pelvic organ prolapse surgery and methods of prevention. Int Urogynecol J. 2013;24(11):1859–72.

    Article  PubMed  Google Scholar 

  6. Doyle PJ, Lipetskaia L, Duecy E, Wood R. Sodium fluorescein use during intraoperative cystoscopy. Obstet Gynecol. 2015;125(3):548–50.

    Article  CAS  PubMed  Google Scholar 

  7. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89:501–6.

    Article  CAS  PubMed  Google Scholar 

  8. Wu JM, Matthews CA, Conover MM, Pate V, Jonsson Funk M. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol. 2014;123:1201–6.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Shull BL. Pelvic organ prolapse: anterior, superior, and posterior vaginal segment defects. Am J Obstet Gynecol. 1999;181:6–11.

    Article  CAS  PubMed  Google Scholar 

  10. Subak LL, Waetjen LE, van den Eeden S, Thom DH, Vittinghoff E, et al. Cost of pelvic organ prolapse surgery in the United States. Obstet Gynecol. 2001;98:646–51.

    CAS  PubMed  Google Scholar 

  11. Claydon CS. The evaluation of pelvic organ prolapse. J Pelvic Med Surg. 1994;10:173–5.

    Article  Google Scholar 

  12. Hinton R, Jinnah RH, Johnson C, Warden K, Clarke HJ. A biomechanical analysis of solvent-dehydrated and freeze-dried human fascia lata allografts. A preliminary report. Am J Sports Med. 1992;20:607–12.

    Article  CAS  PubMed  Google Scholar 

  13. Kobashi KC, Leach GE, Chon J, Govier FE. Continued multicenter followup of cadaveric prolapse repair with sling. J Urol. 2002;168:2063–8.

    Article  PubMed  Google Scholar 

  14. Botros SM, Sand PK, Beaumont JL, Gandhi S, et al. Arcus-anchored acellular dermal graft compared to anterior colporrhaphy for stage II cystoceles and beyond. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20:1265–71.

    Article  PubMed  Google Scholar 

  15. Kohli N, Miklos JR. Dermal graft-augmented rectocele repair. Int Urogynecol J Pelvic Floor Dysfunct. 2003;14:146–9.

    Article  CAS  PubMed  Google Scholar 

  16. Juma S. Recurrent cystocele. Correlation with intrinsic host factors. Neurourol Urodyn. 2015;34(S1):72.

    Google Scholar 

  17. Nygaard I, Brubaker L, Zyczynski HM, Cundiff G, Richter H, et al. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA. 2013;309(19):2016–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Incontinence Research Institute, 320 Santa Fe Dr Suite 108, Encinitas, CA, 92024, USA

    Saad Juma

  2. Department of Urology, University of California San Diego Health System, San Diego, CA, USA

    Omer A. Raheem

Authors
  1. Saad Juma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Omer A. Raheem
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Saad Juma.

Ethics declarations

Conflicts of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Juma, S., Raheem, O.A. Solvent-dehydrated dermal allograft (AXIS™) augmented cystocele repair: longitudinal results. Int Urogynecol J 28, 1159–1164 (2017). https://doi.org/10.1007/s00192-016-3245-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-016-3245-8

Keywords

Search

Navigation