Purpose: To evaluate long-term functional and anatomical results of laparoscopic-sacral colpopexy (LSC) for the treatment of high-grade cystoceles.
Material: Between 1997 and 2005, 43 women with symptomatic cystoceles of high grade (grade 3 or 4), isolated or not, were treated by LSC. All patients were seen at three months, six months and then yearly during follow-up. Each visit included an interrogatory searching for functional urinary symptoms or sexual and digestive symptoms. A clinical examination, always performed by the same operator, searched for an anatomical recurrence, which was defined by an anterior prolapse of stage greater or equals to 2. In addition, a uroflowmetry was performed systematically. Prognostic factors for cystocele recurrence were established by univariate analysis.
Results: With a mean follow-up of 4.1 years (2-10.1), the rate of correction of cystocele was 84%. Seven women had an anterior recurrence and were as follows: stage 2 (n=5), stage 3 (n=1) and stage 4 (n=1) associated with urinary-functional symptoms in three cases, with sexual problems in three cases or with rectal symptoms in two cases. In case of isolated cure of cystocele, we found no recurrence during follow-up. Mean uroflowmetry was 24+/-9ml/s. Nine women (21%) had dysuria associated with cystocele recurrence in four cases. Four patients had a pollakiuria (n=1), an urgenturia (n=1) or a stress-urinary incontinence (n=2) without anatomical recurrence. In a case, chronic-pelvic pain was revealing erosion of the tape into the bladder wall. No significant factor was associated with cystocele recurrence.
Conclusion: LSC offered a viable and long-lasting correction of high-grade cystoceles, mostly when they are isolated. Anatomical recurrence was mainly revealed by the occurrence of functional symptoms. In case of atypical urinary symptoms, a cystoscopy has to be done to look for an erosion into the bladder wall.