Genital prolapse: epidemiology, clinic and therapeutic at Saint Joseph Hospital of Kinshasa.

The aim of the study was to describe the epidemiological, clinical and therapeutical profile of genital prolapse in the gynecology and obstetrics service of Saint Joseph Hospital of Kinshasa. This is a descriptive study carried out from medical files of patients who have suffered from genital prolapse in the gynecology and obstetrics service of Saint Joseph Hospital from January 1st, 2008 to December 31st, 2017. It is based on the no probabilistic sampling of suitability. We recorded 161 cases of genital prolapses upon 13957 patients. The genital prolapses frequency was 1.2% with an annual average of 16.1 cases (SD 10.1) per year. The symptomatology consisted of pelvic mass associated with urinary and digestives troubles (94.0%, n=140). The stage III of cysto-colpocele was the most frequent (56.0%, n=82). The vaginal hysterectomy associated to rectocele and cystocele cure was the most performed operation (52.0%, n=69). The recurrence rate was of 2.0% (3 out of 148 cases). The genital prolapse really exist in our milieu, its symptomatology is classical and its treatment is mostly surgical by vaginal access.

Influencia de los pesarios en la calidad de vida de las mujeres con prolapso de órganos pélvicos / No disponible

El prolapso de órganos pélvicos es una condición patológica que impacta negativamente en la calidad de vida de la mujer. Ocurre cuando los músculos, los ligamentos y las fascias del suelo pélvico se estiran y se debilitan, dejando de proporcionar un sostén adecuado, pudiendo descender y salir al exterior (1). La prevalencia está estimada de un 43% a un 76% de la población femenina general, siendo la etiología compleja y multifactorial (2). El pesario es un dispositivo que se instala en la vagina para proveer soporte a los órganos pélvicos. La importancia de su utilización reside en mejorar significativamente la calidad de vida de la paciente y evitar una intervención quirúrgica. El tratamiento es mínimamente invasivo, de bajo coste, seguro y efectivo. Se recomienda cuando la cirugía representa un riesgo mayor a los beneficios (3)

Pelvic organ prolapse is a pathological condition that negatively affects women's quality life. It occurs when the muscles ligaments and tissues supporting the pelvic organs become weak or loose. Then, the pelvic organs can droop down and bulge out of the vagina. The prevalence in women is estimated to be between 43 and 76%, etiology is complex and multifactorial. A pessary is a device inserted into the vagina to support areas that are affected by pelvic organ prolapse. The potential benefit that derives form pessary use is the significant improvement in the patient's quality of life. Thus, pessary treatment allows surgery to be avoided. It is minimally invasive, inexpensive, safe and effective treatment. It is therefore recommended when surgery may pose greater risk than benefit

A Novel Presentation of Bladder Mass: Self-palpation by a Patient With Cystocele.

INTRODUCTION: This case describes diagnosis of a T2 transitional cell carcinoma in an 89-year-old woman with known cystocele and urinary retention managed with clean intermittent self-catheterization. CASE: While self-catheterizing, the patient noted a palpable mass in her cystocele. She eventually pursued urologic evaluation of this mass, which ultimately led to her diagnosis. This is the first reported case of transitional cell carcinoma being found on self-examination by palpating a cystocele.

Pelvic organ prolapse: the impact on quality of life and psychological well-being.

The aim of this work is to propose a brief comment about the impact of pelvic organ prolapse on the quality of life and the psychological well-being of the affected women.

The hybrid technique of pelvic organ prolapse treatment: apical sling and subfascial colporrhaphy.

INTRODUCTION AND HYPOTHESIS: The majority of patients with cystocele undergoing reconstructive surgery have combined defects of pubocervical fascia and uterosacral/cardinal ligament complex. In this regard, the simultaneous correction of both defects is rational. Furthermore, decreasing the use of synthetic materials in pelvic floor surgery is an important goal. The aim was to evaluate the objective and subjective cure rate of a hybrid technique: bilateral sacrospinous fixation using modern monofilament synthetic tape (apical sling) combined with the original technique of subfascial colporrhaphy. MATERIALS AND METHODS: This prospective study involved 148 women suffering from cystocele combined with apical prolapse. We used the following criteria to evaluate the results of surgical treatment: results of the vaginal examination (POP-Q system), urodynamic tests, bladder ultrasound, special questionnaires (Pelvic Floor Distress Inventory [PFDI-20], Pelvic Floor Impact Questionnaire [PFIQ-7], Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire [PISQ-12], International Consultation on Incontinence Modular Questionnaire Short Form [ICIQ-SF]). All listed parameters were determined before the surgery and at control examinations at 1, 6, and 12 months after the treatment. RESULTS: At the 1-year follow-up, the objective cure rate for prolapse was 97.8%. The rate of anatomical recurrence was 2.2% (3 out of 138). The following long-term complications were noted: de novo urgency and stress urinary incontinence de novo in 2 (1.4%) and 4 (2.9%) patients, respectively. Comparison of the scores by the questionnaires also revealed a significant improvement in the quality of life in the postoperative period. Patient satisfaction rate was 97.1%. CONCLUSION: The hybrid technique is an effective and safe uterus-sparing method for patients with advanced forms of cystocele combined with apical prolapse. This technique improves voiding function, quality of life, and provides a high satisfaction rate.

Automatic Cystocele Severity Grading in Ultrasound by Spatio-Temporal Regression.

Cystocele is a common disease in woman. Accurate assessment of cystocele severity is very important for treatment options. The transperineal ultrasound (US) has recently emerged as an alternative tool for cystocele grading. The cystocele severity is usually evaluated with the manual measurement of the maximal descent of the bladder (MDB) relative to the symphysis pubis (SP) during Valsalva maneuver. However, this process is time-consuming and operator-dependent. In this study, we propose an automatic scheme for csystocele grading from transperineal US video. A two-layer spatio-temporal regression model is proposed to identify the middle axis and lower tip of the SP, and segment the bladder, which are essential tasks for the measurement of the MDB. Both appearance and context features are extracted in the spatio-temporal domain to help the anatomy detection. Experimental results on 85 transperineal US videos show that our method significantly outperforms the state-of-the-art regression method.

Colposuspensión anterior con fijación a malla transobturatriz: una nueva técnica para el tratamiento del colpocele anterior / Anterior colposuspension with transobturator mesh fixation: a new technique for the treatment of anterior colpocele

Introducción: la zona crítica de sostén apical de la fascia vesicovaginal es el anillo pericervical, el cual no existe en el caso de mujeres histerctomizadas. Por lo tanto, el análisis y el desarrollo de posibilidades terapéuticas para el cistocele con menores recidivas posteriores es un tema crítico en la cirugía uroginecológica. Objetivo: presentar una nueva técnica quirúrgica para el tratamiento del colpocele anterior. Material y método: se presentan los primeros diez casos de pacientes operadas con una nueva técnica quirúrgica en el tratamiento por vía vaginal del colpocele anterior. La técnica denominada CATO (C-colposuspensión, A-anterior, TO-transobturatriz) se basa en la reparación del defecto del colpocele anterior (sea este central, medial o pericervical) mediante tejido propio, el cual se fija a una neoestructura dada por el emplazamiento de una cinta de malla de prolene por vía obturatriz posterior. Resultados: no se registraron complicaciones intraoperatorias; hubo un hematoma vesicovaginal posoperatorio inmediato. En cuanto a los resultados funcionales, no se registraron disfunciones vesicales. En el seguimiento se destaca que todas las pacientes presentan puntos Aa y Ba normales. No se registran complicaciones de la malla utilizada. La técnica resulta segura, respeta la anatomía funcional y es reproducible para el ginecólogo vaginalista entrenado y con conocimiento del abordaje transobturatriz posterior. El seguimiento a largo plazo demostrará si esta nueva técnica desarrollada por nuestro equipo tiene un lugar que ocupar en el arsenal quirúrgico del tratamiento de la patología del piso pélvico.

Abstract Introduction: the critical area of apical support for the vesicovaginal fascia is the peri-cervical ring, which does not exist in women who have undergone hysterectomies. Thus, the analysis and development of new therapies for colpocele with smaller posterior relapse is critical for urogynecologic surgery. Objective: to present a new surgical technique for treatment of anterior colpocele Method: the study presents the first ten cases of women who were operated with a new surgical technique in treatment for anterior colpocele through the vagina. The technique under the name CATO (following the Spanish words: CATO (C-colposuspension, A-anterior, TO-transobturator) is based on repairing the anterior colpocele defect (central, medium or peri-cervical) using her own tissue, which is fixed to a new structure created by placing a mesh ribbon through a posterior transobturator. Results: no intraoperative complications were recorded; there was one case of immediate postoperative vesicovaginal hematoma. As to functional results, no vesical dysfunctions were recorded. Upon follow up, it is worth pointing out all patients show normal Aa and Bb stitches. Nos complications arose for the mesh used. The technique is safe, it respects functional anatomy and may be replicated by trained gynecologists who are familiar with the posterior transobturator approach. Long term follow up will reveal whether this new technique developed by our team may become part of the surgical toolkit for treating pelvic floor pathology.

Resumo Introdução: a zona crítica do suporte apical da fáscia vesicovaginal é o anel pericervical, que não existe nas mulheres histerectomizadas. Portanto, a análise e o desenvolvimento de possibilidades terapêuticas para o cistocele com menores recidivas posteriores é uma tema crítico na cirurgia uroginecológica. Objetivo: apresentar uma nova técnica cirúrgica para o tratamento do colpocele anterior. Material e método: apresentam-se os dez primeiros casos de pacientes operadas com uma nova técnica cirúrgica para tratamento por via vaginal da colpocele anterior. A técnica denominada CATO (Colpossuspensão, A-anterior, TO-transobturatoria) está baseada na reparação do defeito do colpocele anterior (seja central, medial ou pericervical) utilizando tecido próprio, que se fixa a uma neoestrutura dada pela colocação de uma tira de malla de prolene por via obturatriz posterior. Resultados: não foram registradas complicações intra-operatórias ou hematoma vesicovaginal pós-operatório imediato. Com relação aos resultados funcionais, não foram registradas disfunções vesicais. No seguimento se destaca que todas as pacientes apresentam pontos Aa e Ba normais. Não foram registradas complicações da malha utilizada. A técnica é segura, respeita a anatomia funcional e é reproduzível por ginecologista vaginalista treinado e com conhecimento da abordagem transobturatoria posterior. O seguimento em longo prazo demonstrará se esta nova técnica desenvolvida por nosso grupo de trabalho tem um lugar no arsenal cirúrgico no tratamento da patologia do piso pélvico.

Etiopathogenic, therapeutic and histopathological aspects upon the anterior vaginal wall prolapse.

The pelvine organ prolapse (POP) is a condition affecting million of women, with a major impact upon the social and professional life of the patients. According to various studies, it affects approximately 40% of the women aged over 50 years. About 10% of women with POP require a surgical procedure for POP or urinary incontinence. Our study comprised a number of 14 patients, aged between 55 and 70 years, hospitalized and treated in the Clinic of Urology within the Emergency County Hospital of Craiova, Romania, between 2011 and 2013, for second-degree cystocele. Of these, 11 (78.57%) patients had more than two natural deliveries, 10 suffered more than three abortions, and eight (57.14%) women suffered from obesity. The increase of abdominal pressure, induced by chronic coughing, constipation or hard physical work, was identified in more patients. Thus, six (42.8%) patients presented chronic bronchitis, four (28.57%) patients were smokers, eight (57.14%) patients presented chronic constipation, and 10 (71.42%) patients stated that they had performed hard physical work. The presence of effort urinary incontinence, associated to the cystocele, was found in eight (57.14%) cases. The surgical intervention consisted in the performance of a direct cystopexia with a synthetic tent, placed in a transobturatory way, in a "tension free" manner (Perigee System). The post-operatory evolution was a good one; the results after six months showed that 12 (85.71%) women were cured, two (14.29%) cases of cystocele relapsed, while in two patients there maintained the effort urinary incontinence. The histopathological examination of the anterior vaginal wall fragments, harvested during the surgical intervention, showed the presence of a chronic inflammatory infiltrate in the lamina propria of the uterine mucosa, which may cause the post-operatory relapses. We consider that the reduction of the inflammatory process through the administration of anti-inflammatory drugs could reduce the POP onset and progress.

Large rectovaginal fistula due to a cube pessary despite routine follow-up; but what is 'routine'?

Vaginal pessaries are generally considered a safe and effective form of management for pelvic organ prolapse. Serious complications such as rectovaginal fistula can develop with or without regular follow-up. This case report describes the rapid development over a 10-week period of a large rectovaginal fistula in a 75-year-old woman, despite routine follow-up and replacement of her cube pessary. Currently, there is a lack of evidence-based guidelines for pessary care and, in particular, the frequency of pessary replacement. Intervals for pessary replacements vary greatly and are often based on the manufacturer's recommendations. This case highlights the rapidity at which serious complications can develop and also represents the first reported case of a cube pessary-induced rectovaginal fistula.

Colpopexia anterior con uretrosuspensión con monoprótesis sintética en el tratamiento simultáneo del cistocele y la incontinencia urinaria / Use of a synthetic monoprosthesis of monofilament, macropore, polypropylene mesh for the simultaneous cure of cystocele and the stress urinary incontinence

Objetivo: Describir la técnica quirúrgica y los resultados de la cura simultánea del cistocele e incontinencia urinariade esfuerzo (IUE) utilizando una monoprótesis de polipropileno monofilamento macroporosa, basado en el "Nazca TC POP Repair System". Material y Métodos: Estudio retrospectivo, descriptivo de tipo serie de casos. Se recolectaron los datos de 69 pacientes intervenidas en dos centros, uno público y otro privado, entre mayo 2007 y abril 2008 en Lima-Perú. Se recopilaron los datos de 56 pacientes hasta los tres meses post cirugía. Resultados: Las complicaciones más importantes fueron extrusión de malla en 4/69 (6%), recidiva del prolapso en 1/56 (2%), persistencia de la IUE 1/56 (2%, retención urinaria 11/69 (16%), infección urinaria en 16/69 (23%), infección de la cúpula en 9/69 (13%) y hematoma en 3/69 (4%). La curación del cistocele según el POP-Q a los tres meses fue de 53/56 (95%) y la satisfacción de las pacientes fue 96,42%. La cura subjetiva de la IUE fue: curada 48/56 (85,1%), mejorada 7/56 (12,5%) y no curada en 1/56 (1,78%). Conclusiones: El uso de esta monoprótesis puede significar un procedimiento seguro y eficaz para la corrección quirúrgica del cistocele y la IUE.

Objectives: To describe the technique for the simultaneous cure of cystocele and the stress urinary incontinence (SUI) using, polypropylene mesh, based on the "Nazca TC POP Repair System". Materials and methods: Retrospective, descriptive study, case series type. We included 69 patients, operated in two centres, a public and a private one, between May 2007 and April 2008 in Lima - Perú. We compiled the data of 56 patients until three months post surgery. Results: The most important complications were: mesh erosion 4/69 (5.7%), prolapse relapse 1/56 (1.7%), SUI persistence 1/56 (1.7%), urinary retention 11/69 (15.9%). We also had urinary tract infection 16/69 (23.18%), vaginal cupula infection 9/69 (13.04%) and hematoma 3/69 (4.34%). The cure rate with POP-Q system scores three months after surgery was 53/56 (94.64%) for cystocele and the patient satisfaction was 54/56 (96.42%). For SUI, the subjective efficacy for cure was 48/56 (85.71%), improvement in 7/56 (12.5%) and failure in 1/56 (1.78%). Conclusions: The use of monoprothesis can be an effective and sure procedure to repair the prolapse of anterior vaginal wall and SUI.

Incontinencia de orina oculta en mujeres con prolapso genital severo, evidenciada por una prueba minimamente invasiva / Occult urinary incontinence in women with severe prolapse evidenced by a minimally invasive test

OBJETIVO: Evaluar los cambios urodinámicos al corregir el cistocele severo mediante una valva vaginal, para identificar incontinencia de orina oculta.MÉTODO: Estudio prospectivo de 70 mujeres ingresadas a la Unidad de Uroginecología y Cirugía Vaginal de Clínica Las Condes. Criterio de inclusión: Cistocele grado III o IV sintomático. Criterio de exclusión: antecedente de cirugía por incontinencia de orina y/o prolapso genital; presencia de incontinencia de orina clínica. A todas se les realizó medición de la presión de retro-resistencia uretral, mediante urodinamia monocanal sin y con reducción del cistocele severo, por medio del reposicionamiento mecánico de la vejiga por una valva vaginal de Bresky. Además se realizó medición complementaria de cistometría.RESULTADO: Sin corrección del cistocele severo la presión de retro-resistencia uretral fue normal en las 70 pacientes. Al reducir el cistocele severo en 50 (71,4%) mujeres, se encontró alteración de la presión de retro-resistencia uretral. La cistometría identificó detrusor hiperactivo asintomático en 8 mujeres. La incontinencia de orina oculta en las 50 mujeres fue: Tipo I en 1, tipo II en 27, tipo III en 1, tipo II+III en 21.CONCLUSIÓN: Al realizar corrección del cistocele severo mediante valva vaginal, se pueden detectar cambios urodinámicos, que permiten identificar mujeres con incontinencia de orina oculta, que potencialmente pueden expresarla al realizar una restauración quirúrgica del prolapso(AU)

OBJECTIVES: To evaluate the urodynamic changes when a severe cystocele is correct by a vaginal valve to identify occult urinary incontinence.METHOD: Prospective study in 70 women at the Urogynecology and Vaginal Surgery Unit, in Clínica Las Condes. Inclusion Criteria: Symptomatic cystocele degree III or IV. Exclusion criteria: antecedent of incontinence and/o genital prolapse surgery; presence of urinary incontinence symptoms. In all patients the urethra retro-resistance pressure was measured by a non-multichannel urodynamic test with and without cystocele reduction by a vaginal Bresky valve. Additionally a cystometry was realized.RESULTS: In all patients the URP was normal when the severe cystocele was not reduced. When the severe cystocele was reduced in 50 (71.4%) women the URP was altered. The cystometry identify asymptomatic overactive detrusor in 8 women. Occult urinary incontinence in the 50 women was: Type I in 1, type II in 27, type III in 1, type II+III in 21.CONCLUSION: When a severe cystocele is reduced by a vaginal valve, urodynamic changes can be detected and women with occult urinary incontinence may be identified. These women may express symptoms of urinary incontinence when a prolapse surgery is realized(AU)

Effectiveness of transvaginal colporrhaphy with porcine acellular collagen matrix in the treatment of moderate to severe cystoceles.

PURPOSE: The aim of this study was to determine the effectiveness of transvaginal anterior colporrhaphy with the use of porcine acellular collagen matrix in the treatment of moderate to severe cystocele. MATERIALS AND METHODS: This retrospective study included 95 patients who underwent anterior colporrhaphy with the use of porcine dermus from September 2003 through March 2008 at the Gynaecological Department of University General Hospital of Alexandroupolis in Greece. The inclusion criterion was a grade 2-4 cystocele by the Baden-Walker halfway system. Postoperatively patients were evaluated at one, six and 12 months. Objective cure was defined as no or grade 1 cystocele with an asymptomatic patient at 12 months postoperatively. Improved outcome was considered as an asymptomatic patient with a grade 2 cystocele and failure symptomatic patients or with grade 3 or 4 cystocele. RESULTS: All of the patients had a 12-month postoperative follow-up or were noted as a failure prior to the 12-month assessment. The majority of the women were menopausal (88.4%) and overweight (mean BMI 26.1). The overall cure rate was 81.1%, the improvement of the cystocele was 10.5% while the failure rate was 8.4%. The complications we noted were vaginal erosion in 2.01% and graft extrusion in 1.05% of the patients. CONCLUSION: Transvaginal anterior colporrhaphy using porcine dermal in the treatment of moderate to severe cystocele is simple, safe, easily learned and performed with a high success rate and low morbidity.

A historical perspective on cystocele repair--from honey to pessaries to anterior colporrhaphy: lessons from the past.

PURPOSE: Ancient reports of the treatment of anterior vaginal wall prolapse (cystocele) include the use of honey, astringents and even turning the woman upside down. Various objects were inserted into the vagina to correct this condition. These have since evolved to modern day pessaries. There is limited information on the historical surgical management of cystocele. In this review we provide a historical perspective on the treatment of cystocele. MATERIALS AND METHODS: A MEDLINE search was conducted using the words prolapse, cystocele, etiology, anatomy, pathophysiology, classification systems and the modifications in the nonsurgical and surgical techniques involved in cystocele repair. RESULTS: Development of pelvic surgery finds its roots in the Ebers papyrus (1550 BC) and evolved from Hippocrates (400 BC) who used pessaries with pomegranate to reduce uterine prolapse. Other maneuvers were also used. Vesalius was the first to provide a detailed description of the entire female genital tract. Adolf Retzius defined the boundaries of the prevesical space in 1849. The current concepts regarding the etiology of cystocele were proposed in 1912. Modern pelvic organ surgeons have modified these concepts to popularize new surgical approaches to this ancient clinical problem. CONCLUSIONS: These contributions provide a sound basis for future surgical developments.

[Effect of conservative treatment in the management of low-degree urogenital prolapse]. / Apport du traitement conservateur dans la prise en charge du prolapsus urogénital de bas grade. Le devenir après deux ans.

OBJECTIVE: The objective of our study was to determine the respective effects of conservative treatment (pelvic muscle exercises plus advice on healthy living) and the absence of treatment in the management of urogenital prolapse. MATERIALS AND METHODS: Forty-seven women (mean+/-S.D. age: 53.42+/-11.01 years) consulting for genital prolapse (grade I or II cystocele) were randomized into two groups: a conservative treatment group (CTG) and a nontreated group (NTG). The patients' outcomes were rated according to several parameters; a clinical examination, the "Measurement of Urinary Handicap" (MUH) scale, urodynamic tests, the Ditrovie quality of life scale and patient satisfaction on a visual analogue scale (VAS). RESULTS: The immediate post-treatment results showed that pelvic heaviness persisted in only five patients (18.51%) in the CTG compared with fourteen (70%) in the NTG (p<0.001). Furthermore, a significant improvement in the MUH scale score was noted in the CTG compared with the NTG. The Ditrovie score also improved. The maximum urethral closure pressure (MUCP) ranged from 54.4+/-13.23 to 57.81+/-12.8 cm H(2)O in the CTG versus 54.05+/-12.18 to 52.95+/-12.18 cm H(2)O in the NTG. Uroflowmetry revealed a significant improvement in the maximum flow rate. These benefits were maintained two years after cessation of the conservative treatment in 20 of the CTG patients. CONCLUSION: Conservative treatment can be effective in the treatment of low-degree urogenital prolapse and enables the improvement of clinical symptoms and urodynamic parameters. The benefits were maintained two years after treatment cessation.

Patient-selected goals: the fourth dimension in assessment of pelvic floor disorders.

The purpose of the study was to assess the relationship between self-expressed urogynecologic goals, symptoms, and treatment choice. Charts of women presenting for urogynecology consultation were reviewed. Demographics, diagnoses and responses to the pelvic floor distress inventory and medical, social, and epidemiologic aspects of aging questionnaires were recorded. Patients listed urogynecology goals before consultation. We categorized goals into five categories and then compared these categories by symptom type, severity, and treatment. Three hundred five women reported 635 goals (median 2, range 1-6). The number of goals listed per patient did not differ by age, race, comorbidities, or clinical diagnosis (p > 0.05). The most frequent goal category was symptoms (67%), followed by information seeking (12%), lifestyle (11%), emotional (4%), and "other" (6%). Women selecting non-surgical treatment were more likely to list information seeking as primary goal than those who chose surgery (p = 0.009). One third of participants expressed a primary non-symptom goal and were more likely to seek non-surgical therapy.

Long-term anatomical and functional assessment of trans-vaginal cystocele repair using a tension-free polypropylene mesh.

We report a case series of 63 women with cystocele who underwent the same trans-vaginal procedure between October 1999 and October 2002. The polypropylene mesh (GyneMesh, Gynecare, Ethicon, France) was placed from the retropubic space to the inferior part of the bladder in a tension-free fashion. Patients were followed up for 24 to 60 months, with a mean follow-up of 37 months. Fifty-five patients returned for follow-up (87.3%). At follow-up, 49 women were anatomically cured (89.1%), five women had stage 2 anterior vaginal wall prolapse (9.1%), and one had a recurrent stage 3 (1.8%). Functional results and sexual function were also investigated. Fifty-three women had significant improvement in their quality of life (96.4%). There were a total of three cases of local pain around a mesh shrinkage (5.5%) and five vaginal erosions of the mesh (9.1%). Four out of 24 patients had dyspareunia (16.7%). In conclusion, the vaginal repair of anterior vaginal wall prolapse reinforced with a polypropylene mesh was efficient at 2 to 5 years follow-up. However, the first generation of polypropylene mesh we used was responsible for high rates of local complications and dyspareunia. Therefore, the polypropylene mesh has to be improved (lower weight) and the technique has to be documented by a randomized controlled trial before we could recommend its use in clinical practice.