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A new technique for cystocele repair and transvaginal sling: the cadaveric prolapse repair and sling (CAPS).
Urology. 2000 Dec 04; 56(6 Suppl 1):9-14.U

Abstract

A new technique using cadaveric fascia lata for the simultaneous repair of a cystocele and placement of a pubovaginal sling by means of a transvaginal approach is described, and our early results are reported. We refer to this as the cadaveric prolapse repair with sling (CaPS). Fifty patients, ages 37 to 90 years, underwent a new technique for simultaneous cystocele repair and transvaginal pubovaginal sling using a single piece of cadaveric fascia. Maximum follow-up was 6 months (range 1 to 6). A 6 x 8 cm segment of cadaveric fascia lata is placed transvaginally to repair the defect through which the bladder herniates into the vagina and to provide sling support at the bladder neck/proximal urethra. The sling is anchored to the pubic bone with transvaginal bone anchors. The remainder of the fascia is then secured to the medial edge of the levator muscles/pubocervical fascia bilaterally and at the vaginal cuff or cervix with absorbable sutures to reduce the cystocele. Patients are being evaluated with preoperative and postoperative stress, emptying, anatomy, protection, instability (SEAPI) scores as well as with grading of the prolapse based on a 3-grade anatomic classification system. Presenting symptoms have included stress urinary incontinence (SUI) in 13 (26%), urge incontinence in 4 (8%), mixed incontinence in 6 (12%), and pelvic prolapse in 20 (40%). These symptoms are not mutually exclusive; some patients presented with a combination of symptoms. The mean SEAPI scores were 5.51 preoperatively and 0.63 postoperatively, representing a significant improvement (P <0.001). Of the 40 patients whose prolapse was quantified, 1 patient (2.5%) had a minimal cystocele, 16 (40.0%) had moderate cystoceles, and 23 (57.5%) had large cystoceles. After the CaPS, 36 (72%) were completely dry, 3 (6%) had persistent SUI, 1 (2%) had de novo urinary incontinence (UI), 3 (6%) had persistent UI, and 1 (2%) had mixed incontinence. No patient had permanent urinary retention. Transvaginal placement of cadaveric fascia for concomitant sling and cystocele repair provides material of excellent strength for the repair without relying on the inherently weak tissues in the patient with pelvic prolapse. Thus far, the early results with CaPS are extremely encouraging. Long-term follow-up is underway to evaluate the efficacy of this procedure.

Authors+Show Affiliations

Kobashi KC
Tower Urology Institute for Continence and Cedars-Sinai Medical Center, Los Angeles, California, USA. dockatt@aol.com
Mee SL
No affiliation info available
Leach GE
No affiliation info available

MeSH

AdultAgedAged, 80 and overCadaverFascia LataFemaleFollow-Up StudiesHumansLength of StayMiddle AgedReoperationRetrospective StudiesSuture TechniquesTreatment OutcomeUrinary BladderUrinary Bladder DiseasesUrinary Incontinence, Stress

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11114557

Citation

Kobashi, K C., et al. "A New Technique for Cystocele Repair and Transvaginal Sling: the Cadaveric Prolapse Repair and Sling (CAPS)." Urology, vol. 56, no. 6 Suppl 1, 2000, pp. 9-14.
Kobashi KC, Mee SL, Leach GE. A new technique for cystocele repair and transvaginal sling: the cadaveric prolapse repair and sling (CAPS). Urology. 2000;56(6 Suppl 1):9-14.
Kobashi, K. C., Mee, S. L., & Leach, G. E. (2000). A new technique for cystocele repair and transvaginal sling: the cadaveric prolapse repair and sling (CAPS). Urology, 56(6 Suppl 1), 9-14.
Kobashi KC, Mee SL, Leach GE. A New Technique for Cystocele Repair and Transvaginal Sling: the Cadaveric Prolapse Repair and Sling (CAPS). Urology. 2000 Dec 4;56(6 Suppl 1):9-14. PubMed PMID: 11114557.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A new technique for cystocele repair and transvaginal sling: the cadaveric prolapse repair and sling (CAPS). AU - Kobashi,K C, AU - Mee,S L, AU - Leach,G E, PY - 2000/12/15/pubmed PY - 2001/3/17/medline PY - 2000/12/15/entrez SP - 9 EP - 14 JF - Urology JO - Urology VL - 56 IS - 6 Suppl 1 N2 - A new technique using cadaveric fascia lata for the simultaneous repair of a cystocele and placement of a pubovaginal sling by means of a transvaginal approach is described, and our early results are reported. We refer to this as the cadaveric prolapse repair with sling (CaPS). Fifty patients, ages 37 to 90 years, underwent a new technique for simultaneous cystocele repair and transvaginal pubovaginal sling using a single piece of cadaveric fascia. Maximum follow-up was 6 months (range 1 to 6). A 6 x 8 cm segment of cadaveric fascia lata is placed transvaginally to repair the defect through which the bladder herniates into the vagina and to provide sling support at the bladder neck/proximal urethra. The sling is anchored to the pubic bone with transvaginal bone anchors. The remainder of the fascia is then secured to the medial edge of the levator muscles/pubocervical fascia bilaterally and at the vaginal cuff or cervix with absorbable sutures to reduce the cystocele. Patients are being evaluated with preoperative and postoperative stress, emptying, anatomy, protection, instability (SEAPI) scores as well as with grading of the prolapse based on a 3-grade anatomic classification system. Presenting symptoms have included stress urinary incontinence (SUI) in 13 (26%), urge incontinence in 4 (8%), mixed incontinence in 6 (12%), and pelvic prolapse in 20 (40%). These symptoms are not mutually exclusive; some patients presented with a combination of symptoms. The mean SEAPI scores were 5.51 preoperatively and 0.63 postoperatively, representing a significant improvement (P <0.001). Of the 40 patients whose prolapse was quantified, 1 patient (2.5%) had a minimal cystocele, 16 (40.0%) had moderate cystoceles, and 23 (57.5%) had large cystoceles. After the CaPS, 36 (72%) were completely dry, 3 (6%) had persistent SUI, 1 (2%) had de novo urinary incontinence (UI), 3 (6%) had persistent UI, and 1 (2%) had mixed incontinence. No patient had permanent urinary retention. Transvaginal placement of cadaveric fascia for concomitant sling and cystocele repair provides material of excellent strength for the repair without relying on the inherently weak tissues in the patient with pelvic prolapse. Thus far, the early results with CaPS are extremely encouraging. Long-term follow-up is underway to evaluate the efficacy of this procedure. SN - 1527-9995 UR - https://www.unboundmedicine.com/medline/citation/11114557/A_new_technique_for_cystocele_repair_and_transvaginal_sling:_the_cadaveric_prolapse_repair_and_sling__CAPS__ DB - PRIME DP - Unbound Medicine ER -