The vaginal patch plastron for vaginal cure of cystocele: Preliminary results for 47 patients

• Published in: European journal of obstetrics & gynecology and reproductive biology 2001-03, Vol.95 (1), p.73-80
• Main Authors: Cosson, Michel, Collinet, Pierre, Occelli, Bruno, Narducci, Fabrice, Crépin, Gilles
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Cystocele; Female; Genital prolapse; Humans; Medical sciences; Nephrology. Urinary tract diseases; Postoperative Complications - etiology; Retrospective Studies; Urinary Bladder Diseases - surgery; Urinary Incontinence - etiology; Urinary Retention - etiology; Urinary stress incontinence; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urologic Surgical Procedures - methods; Vagina - anatomy & histology; Vaginal plastron
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/S0301-2115(00)00341-9

Objective: We describe a new surgical technique (the vaginal plastron) for the treatment of cystocele by the vaginal route. The technique is based on bladder support by a vaginal strip (6–8 cm in length and 4 cm in width), isolated from the anterior colpocele, left attached to the bladder, associated with a suspension of this strip by its fixation to the tendinous arch of the pelvic fascia by six lateral sutures (three on each side of the plastron). The vaginal plastron is then covered by tucking it under the anterior colporraphy. Study design: We evaluated the short-term functional and anatomical results of the first 47 patients to have undergone this treatment between October 1997 and June 1998. The average age of the patients was 69 years. Cystoceles were associated with urinary stress incontinence in 38.3% of cases, with hysterocele or prolapse of the vaginal dome in 87.2% of cases, with an elytrocele in 19.1% of cases and a rectocele in 70.2% of cases. Of the 45 patients having had a hysterectomy combined with the vaginal plastron or in their past history, 44 (99.77%) had a Richter sacro-spino-fixation and 17 (38%) had a Campbell procedure combined with the vaginal plastron. All patients underwent a posterior perineorraphy with myorraphy of the elevators. Results: Average follow-up was 16.4 months with extremes of 6–26 months and concerned 46 patients (one patient was unavailable). Ninety-three percent of the cystoceles were considered treated. One case of imperfect anatomical outcome was noted (persistence of stage 1 cystocele in one patient) together with two other cases of failure of the treatment of cystocele (relapse to stage 2 cystocele). Conclusion: Proposed as a curative treatment of cystocele and combined with the Richter fixation, the plastron provides a surgical solution to the problem of cystocele relapse arising after vaginal treatment of prolapse by sacro-spino-fixation alone (10–20% according to Richter). Short-term results are encouraging, however, medium- to long-term results (36–60 months) are necessary in order confirm the usefulness of this surgical technique.