JOURNAL OF FEMALE
To investigate the feasibility of using a single piece of cadaveric
dermal graft for the
repair of stress urinary incontinence (SUI) with concurrent cystocele.
METHODS: Nineteen patients with combined SUI and symptomatic grade III
cystoceles were treated. Eleven of 19 patients had undergone prior repairs
for SUI. All patients underwent a combined pubovaginal sling procedure and
cystocele repair using a single piece of cadaveric dermal graft
(3 x 7 cm). The single strip of dermal graft was placed in a
longitudinal direction along the anterior vagina. The distal segment of
the graft supported the
urethra, and the proximal portion supported the central cystocele defect
and was sutured to the pubocervical fascia. The mean follow-up was 28 +/-
4 months and patients were monitored by physical examination,
videourodynamic studies, and completion of the bladder bothersome visual
Of the 19 patients, 1 developed an acute infection and failure of the
graft after presenting with fever, discharge, dysuria, and incontinence.
The autolysed graft was removed, and she subsequently underwent successful
autologous fascial repair. Of the remaining 18 patients, 17 were cured of
their SUI, including 10 who had had prior repairs, and 16 had no
recurrence of cystocele and 2 had asymptomatic grade I and II cystoceles.
One patient developed de novo detrusor instability that was successfully
treated with anticholinergic medication. No cases of urethral obstruction
Although the follow-up was short, the use of a single piece of cadaveric
dermal graft slings for concomitant pubovaginal sling and cystocele repair
is feasible and simple to perform. At more than 2 years of follow-up,
documented by videourodynamic studies, neither urethral obstruction nor
symptomatic cystocele recurrence was found.
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