The Elevate™ Anterior mesh is designed to correct the anterior vaginal wall defect by providing level 1 and 2 support via a single incision and transvaginal approach. Our institution began using this mesh in 2011. This study aims to examine the objective and subjective outcomes following severe (Grades 3 and 4) cystourethrocele repair using the Elevate™ Anterior kit by a single surgeon in our centre, looking at its safety, efficacy, and associated complication rates.

A retrospective review of 83 patients with Grade 3 and 4 cystourethrocele who underwent a single incision transvaginal mesh using the Elevate™ Anterior Kit from 01 October 2011 to 31 December 2012 was conducted. Peri- and post-operative complications were recorded, and follow up intervals arranged at 1, 6, 12, 24, 36, 48, and 60 months post-surgery. A standardised questionnaire directed at both urinary, pain and recurrence symptoms was used for all patients during each follow up visit. Speculum and vaginal examinations were performed in all patients at each follow up visit to assess for objective cure and for detection of complications, including mesh exposures. The primary outcome was to assess the cure rate defined as a patient with cystourethrocele less than or equal to Grade 1.

Eighty three patients were studied and the mean age was 64.9 years, with 81 (97.6%) patients being menopausal. Majority of these patients (98.8%) had previous vaginal deliveries. Approximately 27% of patients had concomitant urinary symptoms, such as urinary incontinence, urgency and voiding difficulties. Both subjective and objective cure rates at 60 months were 100%. Two (2.4%) intra-operative complications were recorded with 1 having excessive blood loss more than 500 mls, and 1 having rectal perforation during concomitant posterior repair for rectocele. Post-operatively, 3 (3.6%) patients had fever and 1 (1.2%) had voiding difficulty associated with urinary tract infection.

At 60 months, there were no subjective symptoms of de novo stress or urge incontinence, prolapse symptoms, pelvic pain or dyspareunia. Objective assessment revealed no prolapse recurrences or mesh exposures. All the patients were satisfied after surgery.

Our five-year experience with the Elevate™ Anterior kit showed excellent subjective and objective outcomes in patients with severe cystourethrocele and has high patient satisfaction rates with no increased risk in complications such as mesh exposures or pelvic pain. As there were no anterior prolapse recurrences in our study, the Elevate™ Anterior kit has proven its long-term efficacy in achieving optimal treatment outcomes.