Anterior Transobturator Polypropylene Mesh in the Correction of Cystocele: 2-Point Method vs 4-Point Method

Study Objective: To compare the effectiveness and safety of 2 anterior transobturator mesh methods for treating anterior vaginal wall prolapse. Design: Randomized controlled study (Canadian Task Force classification I). Setting: University hospital. Patients: Eighty-seven women with anterior vaginal wall prolapse stage ≥2 (Pelvic Organ Prolapse Quantification [POP-Q]) underwent an anterior transobturator mesh procedure using macropore polypropylene mesh. Interventions: Forty-five patients underwent the operation via the conventional 4-point, full-sized mesh method, and 42 patients underwent the operation via a novel 2-point, half-sized mesh method. Measurements and Main Results: Patient characteristics were comparable between the 2 groups. The anatomic cure rate was significantly lower in the 2-point group compared with the 4-point group at 12 months after surgery (87.2% vs 100%; p = .03). Healing abnormalities were significantly higher in the 2-point group than in the 4-point group (12.8% vs 0%; p = .03). Bladder perforation (2.6% vs 0%), stress urinary incontinence (23.1% vs 22.5%), urinary frequency (12.8% vs 22.5%), and voiding difficulty and dyspareunia (0% vs 0%) were not statistically different between the 2 groups. At linear regression analysis, mean (SD) operation time did not differ between the 2 groups (74.9 [32.7] minutes vs 87.8 [36.7] minutes; p = .11). Conclusion: Compared with the 4-point method, the 2-point anterior transobturator mesh method resulted in a lower rate of anatomic cure and a higher rate of healing abnormality.