Mesh Reinforcement Cuts Cystocele Recurrence.

CHICAGO -- Reinforcing a cystocele repair with an absorbable mesh significantly reduces the incidence of recurrence, ac cording to findings from the first randomized study to evaluate the use of adjunctive materials in cystocele repair.

In the study, 143 women undergoing anterior or posterior colporrhaphy to repair second-and third-degree cystoceles to the hymenal ring and beyond were randomly assigned to receive mesh reinforcement or no mesh, Dr. Sumana Koduri explained at the annual meeting of the Central Association of Obstetricians and Gynecologists.

The material, constructed of micro polyglactin mesh, is absorbed within 6 weeks, providing an advantage over non- absorbable reinforcement materials that tend to erode adjacent tissues, said Dr. Koduri, a fellow in the department of ob.gyn. at Northwestern University, Chicago.

The study also involved a modified technique for placement of the mesh. In the past, synthetic materials have typically been used as an overlay, but in this investigation, the mesh was placed as a "fold in" or insert, which was imbricated into the anterior colporrhaphy sutures.

"We felt that this would protect the suture line, which is probably the weakest point in the repair," Dr. Koduri said, adding that the technique creates more scarring in the area, which helps augment some of the weaker endopelvic connective tissue.

A year after the procedure, 30 of 70 patients (43%) without mesh and 18 of 73 pa tients (25%) with mesh had recurrent cystoceles beyond the midvaginal plane. Eight of the women without mesh and two with mesh had recurrent cystoceles to the hymenal ring.

Recurrence rates for third-degree cystocele only were 2.7% for the mesh group and 11% for the nonmesh group.