Transobturator mesh for cystocele repair: A short- to medium-term follow-up using 3D/4D ultrasound

Objective: Anterior colporrhaphy has been shown to have limited medium-term success rates in cystocele repair. Many clinicians use mesh implants, but their safety and efficacy are controversial. We therefore performed an external surgical audit using three- and four-dimensional pelvic floor ultrasound to study the short- to medium-term results of transobturator mesh placement. Methods: Forty-six women who had undergone transobturator mesh anterior repair using the Perigee™ system were invited back for a follow-up appointment conducted by two non-surgeons. The appointment consisted of a standardized interview, clinical examination using the International Continence Society Pelvic Organ Prolapse Quantification system (ICS POP-Q) and translabial ultrasound examination. Results: The mean follow-up time was 10 (range, 2-24) months. There had been no major intra- or postoperative complications. Thirty-six (78%) patients were subjectively satisfied with the outcome of the procedure. Cystocele recurrence (Stage 2 or 3) was observed in six (13%) patients. There were three (6.5%) cases of mesh erosion. On translabial ultrasound, we observed cystocele recurrence dorsal to the mesh in five women, associated with a marked change in mesh axis on Valsalva, implying dislodgment of the superior anchoring arms. The mesh was measured at a mean of 21 (range, 8.8-37.3; SD, 7.0) mm in length. Conclusions: At 10-month follow-up the Perigee procedure seems to be safe and effective for cystocele repair, with a satisfaction rate of 78%. In some women recurrence may occur due to dislodgment of the superior anchoring arms.