The Application of Polypropylene Mesh in the Anatomical Correction and Functional Improvement of Pelvic Floor Disorders---Morphological and Functional Exploration

Our preliminary study revealed some particular ultrasonographic manifestations in relation to transobturator procedure for stress urinary incontinence. Functional improvement or impairment subsequent to transobturator procedure appears to be a result of morphologic changes affecting the complex interaction between the urethra and the tape. Static ultrasonographic image at rest or during stress was unable to explain this complex relationship between the urethra and suburethral tape. Real-time imaging could demonstrate five different types of urethral descent in relation to the tape during stress. One type of vertical and one type of rotational urethral descent during straining were observed in women whose surgery failed, while two other types of vertical and one of rotational descent were not associated with failure. Bladder neck funneling, a tape located in the proximal half of the urethra, and absence of ultrasonographic urethral encroachment were the independent factors associated with surgical failure. In cases of surgical failure, the mechanical interaction between the tape and urethra seemed to be inadequate to develop a strong pressure zone. Theoretically, good alignment of the tape with apposition to the posterior urethral wall with the hope to gain adequate biomechanical interaction in possibly achieved with the aid of intraopeative ultrasound surveillance. The first object of this study project therefore is to identify the way of intraoperative ultrasound to improve the success rate of transobturator procedure for stress urinary incontinence. The recurrence rate of anterior colporrhaphy has been reported to be in the range of 40 to 60%. Inadequate tissue tensile strength of autologous tissue due to tissue breakage and aging process as well as incomplete repair of the coexisting defects was the attributing factors. The introduction of macroporous type polypropylene mesh has improved the success rate of pelvic reconstructive surgery. Currently, the available commercial kits for anterior colporrhaphy were mainly consisted of a piece of mesh with four supporting arms. The suspension and anchorage of the mesh was achieved by the penetration of the four arms through the arcus tendinae fasciae pelvis and obturator foramen. In the past one year, we have developed a new technique for reinforcement anterior colporrhaphy using Gynecare Gynemesh. After serial postoperative observations, we have found some ultrasonographic features distinctly different from the current concept regarding the development of cystocele and the related surgical technique. The second object of this study project is trying to explore the pathophysiology of recurrent cystocele and to indentify the cost-effective way to repair the large or recurrent cystocele.