Sam Kuykendall*, Sharron Mee, Gary Leach, Los Angeles, CA
INTRODUCTION AND OBJECTIVES: Due to the increasing concerns regarding mesh complications, repairs of pelvic organ prolapse without mesh are at the forefront. Since our initial description of prolapse repair with sling utilizing solvent dehydrated non-frozen cadaveric fascia lata (CaPS) in 2000, we have continued to perform cystocele repair utilizing the same technique. Our objective is to present the updated and long-term data for the repair of cystocele with non-frozen cadaveric fascia lata as an alternative to “kits” in light of the mesh controversy.
METHODS: 432 of 505 (85.5%) patients who have undergone cystocele repair with non-frozen cadaveric fascia lata have at least 12 months of follow-up. A retrospective review of the 432 patients was performed. The outcomes measured included pelvic examination for prolapse recurrence and complications, SEAPI scores and a validated subjective continence and patient satisfaction questionnaire including the patient’s perception of overall improvement. SEAPI scores were obtained pre- and post-operatively. Failure was defined as recurrence of cystocele grade 2 or higher using the Baden-Walker system or re-operation for prolapse.
RESULTS: The average follow-up period with validated questionnaires was 4.8 years (range 12 – 152 months) with 181 patients having at least five-years of follow-up. Average patient age at the time of surgery was 66 years (range 29 – 89). 81% of patients underwent additional prolapse surgery at the time of cystocele repair. Durable and statistically significant percent improvement was observed in total SEAPI score as well as each individual component. Pre-operative total SEAPI score average was 6.8 and post-operative score decreased to 2.4 for a 65% improvement (p<0.001). Complication rate was 4% (denovo urgency, recurrent stress incontinence, urinary tract infection, urinary retention, wound separation) with no severe adverse events and no reoperation required. Of the women who were sexually active, 12% reported discomfort with intercourse. 4% of patients reported pelvic pain. Prolapse failure occurred in 13% (56/432) of patients. At the time of each patient’s last questionnaire, the majority (406; 94%) of patients answered that they would both recommend and repeat surgery. Self-reported patient satisfaction on a visual analogue scale was high as well with an objective 88% improvement from baseline.
CONCLUSIONS: With a maximum follow-up of more than 12.5 years and an average follow-up of almost 5 years, patients undergoing cystocele repair with non-frozen cadaveric fascia lata have results which are excellent and durable. There is a low recurrence rate and high patient satisfaction with no significant morbidity.