Abstract

Objective: The use of synthetic meshes has gained popularity in the surgical treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP). The aim of this study was to assess the efficacy and safety of “self-cut” prolene meshes in the management of SUI and POP.

Materials and methods: Eighty-nine patients underwent SUI and/or POP repair with the use of a 30x30-cm surgical polypropylene mesh (Gal-Mesh). Twenty-three patients (group 1; mean age 52 years) received TOT only, and 66 patients (group 2; mean age 51 years) underwent concomitant POP surgery (58 cystocele, 17 rectocele, 8 uterine prolapse). A prolene mesh strip of 1-cm width was placed as TOT. Anterior repair was performed either with a free, Y-type, or 4-arm mesh and posterior repair with a free mesh, combined with autologous vaginal flaps. Patients with uterine prolapse underwent anterior-posterior mesh repair using the transabdominal approach combined with sacrohysteropexy. The mean follow up was 12.8±6.9 months in group 1, and 13.5±7.1 months in group 2.

Results: Dryness was achieved in 21 patients (91.3%) in group 1, and in 59 patients (89.4%) in group 2. De novo urge symptoms were seen in one patient (4.4%) and five patients (7.6%) in group 1 and 2, respectively. Bladder and rectal perforations occurred in two patients and one patient in group 2, respectively, and were repaired primarily. Anatomical cure was achieved in all the patients without any recurrence of POP. One patient in group 1 required mesh incision due to obstruction at day 25. Vaginal erosion was detected in two patients at 6 and 18 months following anterior repair using combined Y-type and 4-arm anterior meshes. None of the patients developed wound infection, pelvic abscess, or urethral erosion. 

Conclusion: Surgical management of SUI and POP with “self-cut” polypropylene meshes yields similar success and complications rates to those reported for industrial kits. Considering the conditions of our country, the use of these techniques may greatly decrease the cost of the procedure.