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Biological Grafts
Miss Michelle Fynes MB BAO BCH (Hons) MRCOG DU DipUs MD (Research)
Consultant Subspecialist Urogynaecologist
Department of Reconstructive Pelvic Surgery
& Urogynaecology
St George’s Hospital and
Honorary Senior Lecturer St. Georges University of London
/ /
Suture Placement:
Paravaginal
Central Defect “6-Point Suspension”
Defect Repair
Covered
Apical
Suspension:
Comparing
Devices
Posterior IVS
Apogee
Prolift
Capio
• Cut suture in 2 to get 2 throws
• Remember needle tip
Placement of Capio Sutures
Xenform™ Tissue Repair Matrix
Advantages Disadvantages
Aim: Compare acellular dermal matrix to standard colporrhaphy for repair cystoceles.
Methods: 102 patients with > Stage II anterior prolapse (Aa or Ba 0) underwent anterior
colporrhaphy with acellular dermal implant attached to arcus, between 10/2003 and
02/2007 were compared to 89 controls who received standard anterior colporrhaphy.
Objective recurrence was defined as > Stage II (Aa or Ba -1).
Results: The dermal graft and colporrhaphy groups were comparable in age, parity, BMI
and concomitant surgeries except hysteropexy and hysterectomy. Regression was
performed for possible confounders. Postoperatively, 14 (19%) recurrences were identified
in the dermal graft group vs. 26 (43%) in the colporrhaphy group (p=0.004). Two patients
underwent reoperations for cystocele recurrence in the study group versus four in the
control group. Time to normal voiding, subjective stress urinary incontinence, EBL and
length of hospital stay did not differ between groups.
Conclusion: Dermal acellular matrix provides benefit over standard colporrhaphy.
N (%) N (%)
Anterior recurrence (Aa or Ba to -1) 14(19%) 26 (43%) 0.004
Anterior recurrence (Aa or Ba to 0) 7 (10%) 14 (23%) 0.04
Anterior recurrence (Aa or Ba past 0) 3 (4%) 2 (3%) 1.0
Posterior recurrence (Ap or Bp to -1) 9 (13%) 4 (7%) 0.25
Posterior recurrence (Ap or Bp to 0) 4 (6%) 3 (5%) 1.0
Apical recurrence (c or d to -1) 6 (8%) 6 (10%) 0.69
Postoperative UUI1 26 (41%) 11 (22%) 0.04
Postoperative SUI1 14 (22%) 5 (10%) 0.10
Postoperative dyspareunia1 (n=21 missing) 7 (14%) 8 (19%) 0.49
OBJECTIVES: To systematically review the efficacy and safety of mesh/graft for anterior or posterior
vaginal wall prolapse surgery.
SELECTION CRITERIA: Randomised controlled trials (RCTs), nonrandomised comparative studies,
registries, case series involving at least 50 women, and RCTs published as conference abstracts from 2005
onwards.
ANALYSIS: 3 groups: anterior, posterior, anterior +/- posterior repair (not reported separately).
RESULTS: 49 studies (N=4569) mesh/graft POP repair. Median follow up 13 months (R 1-51) For Anterior
repair, short-term evidence that mesh/graft (any type) significantly reduced objective prolapse recurrence
rates compared with no mesh/graft (relative risk 0.48, 95% CI 0.32-0.72).
BJOG 2008
Conclusions