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• W1966079641 abstract "OBJECTIVE: The objective of this study was to compare preliminary outcomes for patients receiving an anatomically anchored acellular dermal matrix (Repliform) with age-matched controls receiving standard anterior colporrhaphy for the repair of cystoceles to the hymenal ring or beyond. METHODS: Fifty-nine patients with ≥ stage II anterior prolapse (Aa or Ba 0) underwent anterior colporrhaphies augmented with an acellular dermal implant from November 2003 to November 2004. Forty-two patients completed 12-week follow up at the time of this assessment. The dermal graft (4 × 7 cm) was placed longitudinally and attached at 3 levels to ATFP, reestablishing bilateral paravaginal supports. The proximal graft was anchored to the vaginal apex across the midline, restoring level I fascial continuity. Proximal graft corners were sutured to either the ipsilateral proximal ATFP (n=31) or sacrospinous ligament (n=11) for women undergoing concomitant apical suspension. Forty-two age matched controls (Aa or Ba 0), who underwent standard anterior colporrhaphy alone, were identified for comparison of outcomes at 12 weeks. POP-Q staging was performed preoperatively and 6 and 12 weeks postoperatively. Objective recurrence was defined as ≥ stage II (Aa or Ba-1). Secondary outcomes included incontinence, dyspareunia, EBL, and time to normal voiding. The PFDI, PISQ-12, and IIQ-7 were administered to graft patients pre- and postoperatively. Chi-squared, McNemar's, and Student t tests were used for comparison. RESULTS: Mean age (60.6 vs 62.8, P=0.54), parity (2.5 vs 2.8), body mass index (26.4 vs 25.5), prior recurrences (P=0.69), prior SUI surgery (P=0.29), and concomitant surgeries with the exception of more bladder neck slings in the colporrhaphy group (P=0.002) did not differ between the 2 groups. Postoperatively, 5 recurrences (12%) were identified in the dermal graft group versus 12 (29%) in the colporrhaphy group (P=0.05). Of these, recurrence to the hymenal ring or beyond occurred in 2 (5%) versus 7 (17%) patients (P=0.06). One patient in each group underwent repeat surgery; additionally, 2 patients in the control group are considering surgery. Time to normal voiding (9 vs 8 days), retention (P=0.57), stress (P=0.35), and urge (P=0.37) urinary incontinence, detrusor overactivity (P=0.20), EBL (287 vs 302 cc), and hospital stay (1.5 vs 1.7 days) did not differ between groups. QOL scores improved significantly postoperatively. CONCLUSION: Few comparative trials evaluate the efficacy of adjuvant graft materials for anterior compartment prolapse repair, and we present the first comparative trial of a biologic adjuvant material attached to the ATFP. These findings suggest that anchored acellular dermal grafts result in markedly improved outcomes for patients with prolapse extending to the hymenal ring or beyond without significant complication or discomfort. We believe that anatomically based fixation of the grafts results in the restoration of fascial continuity at all levels and may represent an important aspect of their success. Longer-term follow up of this observational cohort is ongoing at our center." @default.
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• W1966079641 date "2005-01-01" @default.
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• W1966079641 title "Poster 57: Adjuvant Dermal Graft for Advanced Anterior Compartment Prolapse: Comparison to Standard Anterior Repair" @default.
• W1966079641 doi "https://doi.org/10.1097/01.spv.0000178934.24150.ce" @default.
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