Effectiveness of transvaginal colporrhaphy with porcine acellular collagen matrix in the treatment of moderate to severe cystoceles.

PURPOSE: The aim of this study was to determine the effectiveness of transvaginal anterior colporrhaphy with the use of porcine acellular collagen matrix in the treatment of moderate to severe cystocele. MATERIALS AND METHODS: This retrospective study included 95 patients who underwent anterior colporrhaphy with the use of porcine dermus from September 2003 through March 2008 at the Gynaecological Department of University General Hospital of Alexandroupolis in Greece. The inclusion criterion was a grade 2-4 cystocele by the Baden-Walker halfway system. Postoperatively patients were evaluated at one, six and 12 months. Objective cure was defined as no or grade 1 cystocele with an asymptomatic patient at 12 months postoperatively. Improved outcome was considered as an asymptomatic patient with a grade 2 cystocele and failure symptomatic patients or with grade 3 or 4 cystocele. RESULTS: All of the patients had a 12-month postoperative follow-up or were noted as a failure prior to the 12-month assessment. The majority of the women were menopausal (88.4%) and overweight (mean BMI 26.1). The overall cure rate was 81.1%, the improvement of the cystocele was 10.5% while the failure rate was 8.4%. The complications we noted were vaginal erosion in 2.01% and graft extrusion in 1.05% of the patients. CONCLUSION: Transvaginal anterior colporrhaphy using porcine dermal in the treatment of moderate to severe cystocele is simple, safe, easily learned and performed with a high success rate and low morbidity.

Two-year results of a new two-minute hot liquid balloon endometrial ablation system (Thermablate): a pilot study.

PURPOSE: To evaluate the feasibility, safety and clinical outcomes of a new 2-minute hot liquid balloon endometrial ablation system (Thermablate). MATERIAL AND METHOD: This prospective observational study included 72 premenopausal women with menorrhagia. All patients were treated from February 2005 through February 2008 under general anaesthesia in the Department of Obstetrics and Gynaecology at the University Hospital of Alexandroupolis, Greece. Thinning of the endometrium was achieved by sharp curettage immediately prior to the procedure. Pretreatment evaluation of menstrual blood flow, duration of menses and frequency of menses were recorded on all patients. Patient records were screened for adverse events, post procedure pain and required medication, dysmenorrhea, satisfaction and menstrual bleeding patterns. RESULTS: Follow-up at three months (n = 72), 6 months (n = 62), 12 months (n = 47) and 24 months (n = 17) showed a trend towards reduced monthly blood flow. Combined amenorrhea and hypomenorrhea rates at 3, 6, 12 and 24 months were 39%, 73%, 77% and 70%, respectively. The corresponding satisfaction rates were 86%, 93.5%, 93.5% and 82.4%, respectively. Dysmenorrhea rates increased from 37.5% prior to surgery, to 57% at three months and decreased to 23.5% at 24 months (p < 0.0001). CONCLUSION: Endometrial ablation with the Thermablate system is a safe and effective therapy for dysfunctional uterine bleeding when other therapies are contraindicated or have been tried and failed.