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Abstracts from oral presentations to the Blair Bell Research Society meeting held at Liverpool Women's Hospital, 3-4 May 2001

Anterior colporrhaphy is associated with a recurrent rate of up to 20 per cent, a problem that is thought to arise at least in part from tissue tension. This study was designed to evaluate the role of a tension-free repair using polypropylene mesh. Twenty women (mean age 61·3 years and parity 2·95) with symptomatic cystocele but no significant urinary incontinence took part in the study. The symptoms and degree of prolapse were recorded preoperatively, 6 weeks, 6 months, 1 and 2 years postoperatively. Following mobilisation of the bladder, a piece of polypropylene mesh (Gynaemesh, Ethicon, UK) was attached to the tissue at the ‘white line’. Excess skin was excised and the vagina closed with a continuous suture. Results. The mean follow-up was 21·7 months (range 14–33). The mean hospital stay was 1·95 days. There were no intraoperative complications. A vaginal pack was required in one woman because of postoperative bleeding. There were three drop-outs: one had a hysterectomy for second degree uterine prolapse, another had ovarian carcinoma and the third had the mesh removed because of a persistent failure of healing. In the first four subjects the cystocele was graded ‘moderate’ and 13 had ICS staging (nine had stage II cystocele, four had stage III). At the last follow-up, 12 had no cystocele, four had stage I and one had stage II symptomatic recurrence. Conclusions. Our results suggest that the tension-free cystocele repair is safe, but a larger randomised study comparing mesh repair with anterior colporrhaphy will be required to assess their relative merits, especially recurrence.