ORIGINAL ARTICLE Anterior compartment prolapse repair with a hybrid biosynthetic mesh implant technique Jose E. Robles & Jorge Rioja & Abel Saiz & Xavier Brugarolas & David Rosell & J. Javier Zudaire & Jose M. Berian Received: 22 September 2006 / Accepted: 21 December 2006 / Published online: 24 January 2007 # International Urogynecology Journal 2007 Abstract The aim of the present study is to assess the safety and feasibility of a new technique for cystocele repair using a hybrid biosynthetic graft fixed by the transobturator approach. This is a retrospective study of 13 women diagnosed with symptomatic anterior compart- ment prolapse that were in stages II and IV, using Pelvic Organ Prolapse Quantification score and treated between 2003 and 2006. The surgical procedure was carried out through a vaginal approach, exposing the arcus tendineus and the posterior surface of the obturator foramen from the ischial spine to the inferior pubic ramus bone. The patients were followed-up after 3, 6 and 12 months. The anatomical cure rate was 85% (stage 0), although two patients had a recurrence 8 months after surgery. All patients would repeat the procedure, if necessary. No de novo dyspareunia was observed in these small series. The results suggest that this technique is safe and feasible and is a comprehensive surgical approach for anterior compartment prolapse, without postoperative morbidity. Keywords Pelvic organ prolapse . Anterior compartment . Cystocele . Porcine acellular collagen . Transobturator route . Mesh repair Introduction Anterior vaginal wall prolapse results from a weakness of the supporting structures of the anterior wall of the vagina, which causes overlying bladder and urethral prolapse [1, 2]. The surgical management of this prolapse remains contro- versial. It has traditionally been repaired with anterior colporraphy, where the vaginal epithelium is separated from the underlying fibromuscular tissue, followed by midline plication of vaginal muscularis with a series of interrupted absorbable mattress sutures, excision of excess epithelium, and closure [3]. The success rate for anterior colporraphy vary widely between 37 and 100%, but in retrospective series the range vary from 80 to 100% [4, 5]. Failure rates between 3 and 20% (up to 49%) [6, 7] have been reported with the classical repair with native tissue after 2–8 years’ follow-up [8, 9]. In an attempt to improve the anatomical cure rates, several variations has been used for correcting the anterior prolapse through the vaginal approach. The variations include ultralateral anterior colporraphy [4], lateral para- vaginal defect repair [10], and anterior colporraphy placing different graft materials on top or in place of the midline plication. The reported indications for graft use are not clear and not universally recognized, but prosthetic reinforce- ment has been employed in both primary and recurrent cystoceles, and numerous studies have been published [11]. The anatomic cure rate for anterior colporraphy using permanent synthetic graft materials ranges from 42 to 100%, and the majority of the available data consists of small retrospective series. However, the occurrence of healing abnormalities after graft implantation is becoming increasingly recognized as a potentially serious problem. According to the literature, the rate of mesh exposure via vaginal route varies from 5 to 30%, and the most recent studies report an erosion rate of 8–12% [12]. Other associated complications include infection, dyspareunia, Int Urogynecol J (2007) 18:1191–1196 DOI 10.1007/s00192-006-0298-0 J. E. Robles (*) : J. Rioja : A. Saiz : X. Brugarolas : D. Rosell : J. J. Zudaire : J. M. Berian Urology, Clinica Universitaria, University of Navarra, Pamplona, Spain e-mail: jerobles@unav.es