Anterior repair with or without collagen matrix reinforcement: a randomized controlled trial.

OBJECTIVE: To compare outcomes of anterior colporrhaphy alone to that reinforced with bovine pericardium graft. METHODS: Women with anterior vaginal wall prolapse were enrolled in a randomized fashion in this grafted compared with nongrafted repair study. Outcome measures included pelvic organ prolapse quantification data, quality-of-life assessment, healing abnormalities, and complications. RESULTS: Ninety-four patients were enrolled. Seventy-two (77%) provided 1-year data, and 59 (63%) supplied 2-year data. Demographics and stage of prolapse were similar between groups at baseline. Postoperative complications consisted basically of low urinary tract infection and were low in both groups (10 in bovine pericardium graft and 16 in anterior colporrhaphy alone). One year after surgery, successful anterior vaginal wall support was obtained in 85.7% of the bovine pericardium graft group and 78.4% of anterior colporrhaphy-alone group (P=.544). For the cohort that comprised 2-year analyses, the success rate was 76.5% for the bovine pericardium graft group and 63% for anterior colporrhaphy-alone group (P=.509). Postoperative Urogenital Distress Inventory-6 and Pelvic Organ Prolapse-Urinary Incontinence Sexual Function Questionnaire-12 scores were uniformly improved over baseline in both groups. CONCLUSION: The use of bovine pericardium graft for anterior vaginal prolapse does not have higher complication rates or healing difficulties. At 1- and 2-year follow-up, anterior colporrhaphy with bovine pericardium reinforcement did not show a statistically significant improvement over colporrhaphy alone. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00860912 LEVEL OF EVIDENCE: I.

Novel approach for correction of urethral prolapse using a retropubic sling with urethral fixation.

We describe the novel management of a 68-year-old postmenopausal woman with urethral mucosal prolapse, stress urinary incontinence, and significant pelvic organ prolapse. Successful surgical management of her urethral prolapse was achieved using a retropubic suburethral sling with urethral fixation at the time of anti-incontinence and pelvic reconstructive surgery.

A prospective, randomized controlled trial of the use of an anal purse-string suture to decrease contamination during pelvic reconstructive surgery.

The objective of this study was to evaluate the clinical utility of an anal purse-string suture to prevent contamination of the operative field during vaginal surgery. Patients undergoing vaginal surgery involving the posterior compartment were enrolled to receive a purse-string suture closing the anus (group 1) or to not receive the suture (group 2). Perineal/perianal cultures were performed after sterile preparation and at conclusion of surgery. The primary outcome measure was gross fecal contamination. Secondary outcomes were results of perineal cultures. Continuous and ordinal variables were compared between groups using Wilcoxon rank sum tests, while comparisons of binary variables were performed using exact unconditional tests. Forty (40) patients were randomized. There were no significant differences in the two groups including age (P = 0.95), parity (P = 0.40), operative time (P = 0.75), and estimated blood loss (P = 0.81). Gross contamination rates were 0/40 (0%) for group 1 and 5/19 (26.3%) for group 2 (P = 0.015). Contamination by fecal flora occurred in 2/20 (10%) for group 1 and in 5/20 (25%) for group 2 (P = 0.27). No wound infections, graft erosions, or healing abnormalities were noted in either group. An anal purse-string suture is an effective way of reducing fecal contamination of the sterile field when performing vaginal pelvic reconstructive surgery.