Anterior vaginal wall protrusion in pregnancy: a case report

Vaginal prolapse rarely complicates pregnancy. We experienced a 36-year-old, gravida 3, para 1 woman who presented at 37 weeks’ gestation with gestational diabetes mellitus and a large anterior vaginal prolapse that could not be reduced manually or by bed rest. After obtaining consent, a cesarean section was successfully performed, and a live neonate delivered. The prolapsed anterior vagina recovered spontaneously following the cesarean operation. A vaginal prolapse in pregnancy is rare. Elective or emergency cesarean section is a possible treatment option when the prolapse cannot be reduced manually or by bed rest. Our case highlights the importance of routine obstetric examinations for early detection of a vaginal wall prolapse.

Transvaginal PVDF-mesh for cystocele repair: A cohort study

INTRODUCTION

Optimized biocompatibility of new materials is a major requirement for transvaginal meshes for pelvic organ prolapse (POP) repair. Polyvinylidene fluoride (PVDF) presented good characteristics in prior animal experiments and clinical use in humans.

METHODS

Between 01/2012 and 04/2016 37 women underwent transvaginal repair of symptomatic prolapse of the anterior vaginal wall (cystocele) with PVDF-mesh in a single institution. A chart review for recurrence, continence, peri- and early postoperative complications was performed. Referring practitioners were interviewed by telephone and mail. Additionally patient reported outcome and satisfaction were measured by Patient Global Improvement Inventory (PGI-I) scale.

RESULTS

34 women were eligible for a mean follow up of 19 months. The functional outcome improved significantly. One symptomatic vault prolapse (2.9%) and two reoperations for incontinence (5.9%) occurred. Two mesh exposures (5.9%) occurred and were treated conservatively. No other severe complications were registered. 87.5% of treated women felt very much better or much better and would undergo the surgery again. A cohort study including development steps in accordance with the IDEAL system is presented.

CONCLUSIONS

For the first time we report on effectivity and safety of transvaginal application of PVDF-mesh in real-life practice. A prospective long-term evaluation in a registry is justified.