الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 185 |  |  |
| | | from | 185 | | |
Abstract
Pelvic Organ Prolapse (POP) has afflicted women since the beginning of mankind, even though we have been faced with this problem for so many centries, we still have not found away to overcome gravity and prevent prolapse. Up to 50% of parous women have some degree of genital prolapse although only 10-20% are symptomatic, the lifetime risk of having an operation for prolapse may be 11% and almost one third of cases require reoperation. Considering pelvic organ descent as a hernia through the genital hiatus, prosthetic material has been advocated in gynecology deriving from its use in general surgery for hernia repair, as a reinforcement or replacement of natural structure.
Objectives: The aim of this study was to compare between classical repair and vaginal repair by prolene mesh as a surgical treatment for vaginal prolapse. This study was conducted in Zagazig University Hospitals from January 2009 to January 2011, 40 patients with stage II or more vaginal wall prolapse according to POPQ system were enrolled and assigned randomly to either classical repair (no mesh group = 20 patients) or repair with prolene mesh (mesh group = 20 patients). The anatomic outcome was assessed by comparing the preoperative and postoperative POPQ stages after 6 months. Cure was defined as POPQ stage 0-I and absence of surgical reintervention for prolapse. Failure was defined as ≥ stage II anatomic outcome. The functional outcome was assessed by comparing the occurrences of preoperative and postoperative symptoms after 6 months.
Results: Regarding functional outcome, urinary, bowel and sexual symptoms of prolapse were all significantly improved in both groups. However, improvement was more significant in patients who underwent vaginal repair with prolene mesh with respect to dyspareunia. Regarding POPQ measurements, points Aa, Ba, Ap and Bp were significantly improved in patients who underwent repair with prolene mesh when compared with that patients who underwent classical repair. Accordingly, anatomic outcome was optimal in 35%, satisfactory in 40%, and unsatisfactory optimal in 35%, satisfactory in 40%, and unsatisfactory in 25% of patients who underwent classical repair. Thus, cure rate was 75%, while failure rate wsa 25%. On other hand, anatomic outcome was optimal in 75%, satisfactory in 20% and unsatisfactory in 5% of patients who underwent repair using prolene mesh. Thus, cure rate was 95% while failure rate was 5%. Regarding morbidity, the erosion rate of vaginal mesh was low and occurred only in one patient (5%) which was managed conservatively by systemic and topical oestrogen.
Conclusion: Pelvic reconstructive surgery with polypropyrlene mesh reinforcement is a safe, simple, inexpensive and promising procedure for patients with advanced POP as it offers good results and the rate of complication is acceptable at short-term follow up. The use of polypropylene mesh for vaginal prolapse repair is superior to standard classical repair as regard anatomical outcome. Although the incidence is low, mesh exposure and erosion may develop postoperatively. Thus, preoperative patient consultation is necessary for these possible risks.
.