Porcine dermal hammock for repair of anterior and posterior vaginal wall prolapse: 5-year outcome

STUDY OBJECTIVE: To estimate the long-term efficacy of acellular cross-linked porcine dermal implants for the substitution of prolapsed anterior and posterior endopelvic fascia. In addition, surgical techniques to improve outcome were examined. DESIGN: Prospective longitudinal study (Canadian Task Force classification II-2). SETTING: Private urogynecology clinic. PATIENTS: Patients were reviewed who had Pelvic Organ Prolapse Quantification stage 2 or greater anterior and/or posterior pelvic floor defects repaired with porcine dermis from March 2000 through August 2002 with at least 5 years of follow-up. INTERVENTIONS: Repairs consisted of endopelvic fascia implants side wall to side wall from the ischial spine to the vaginal introitus. Different techniques of dissection, wound closure, and tissue pliability were measured. MEASUREMENTS AND MAIN RESULTS: A total of 91 consecutive patients had endopelvic porcine dermal implants for pelvic organ prolapse. In all, 72 patients with a total of 82 defects had an objective cure rate of 81.6% and 86.4% at 5 years for anterior and posterior repairs, respectively. Concomitant anterior and posterior repairs had a 6 times higher objective failure rate. The method of dissection and mucosal wound closure significantly affected wound healing. Solid porcine implants had decreased tissue pliability. A significant improvement in quality-of-life questionnaires and high patient satisfaction occurred, shown by a visual analog scale. CONCLUSION: Complete replacement of the endopelvic fascia with porcine dermis had a better outcome than reported in many studies using classic plication or plication augmentation repairs. Porcine was well tolerated with high patient satisfaction and improved quality of life. Solid dermal implants resulted in thick scar plates, yet had a low occurrence of de novo dyspareunia and did not appear to adversely affect sexual activity.