Transvaginal treatment of anterior vaginal prolapse with a transobturator fixation of porcin collagen implant; [Traitement des prolapsus vaginaux antérieurs par voie vaginale avec implant de derme porcin fixé en transobturateur]

Objective: To assess the feasibility and efficacy of a porcine skin collagen (Pelvicol™) implant by a vaginal route and a transobturator (TOT) fixation for the treatment of cystoceles. Patients and methods: In a retrospective study, 46 patients with vaginal prolapse stages 2 to 4 underwent anterior colporrhaphy associated Pelvicol™ implantation to correct their bladder prolapse: the bladder was dissected via a transvaginal approach and the graft was fixed laterally by a TOT route. The patients were reviewed at 1.6 month and every year. An anatomic success was defined by a stage inferior or equal to 1, and satisfactory by an asymptomatic stage 2. A failure was defined by a symptomatic prolapse and/or a stage superior or equal to 3. Results: Porcine skin collagen implantation was feasible in every case. Mean follow-upwas 25 months [12-36]. No vessel and no bladder injury occurred during the procedure. The postoperative complications were a case of urethral plicature and a spontaneous expulsion of the graft due to a hematoma. An associated procedure was necessary in 78.3%of cases. We observed three cases of recurrences with only one surgical reintervention (at the 12th month for an invalidating stage 3). Forty-three (93.5%) patients had a complete resolution of the prolapse and 98% a good functional result. Conclusion: The technique is reproducible, and a low rate of complication was observed. The median-term results are very satisfactory and need to be confirmed by a long-term evaluation. © Springer Paris 2009.