Cystocele and stress urinary incontinence synthetic repair using a self-tailored polypropylene mesh

Objectives: we present a video of our technique for the management of stress urinary incontinence and vaginal prolapse, using a self-tailored polypropylene mesh. Material and methods: for economic reason we use a polypropylene monofilament mesh of 15/15 cm for transobturator tape treatment of stress urinary incontinence and for cystocele synthetic repair. For the sub-urethral sling, a tape of 1 cm large and 15 cm long is harvested from the polypropylene mesh. A vaginal incision under the mid-urethra is performed and then the mesh is implanted with the transobturator outside-in technique. The cystocele mesh is tailored from the remaining 14/15 cm polypropylene mesh, with 2 or 4 arms. A transversal vaginal incision is performed 1 cm above the cervix. The vaginal wall is dissected from the bladder. The cystocele mesh is placed through the vaginal incision and the arms are placed with the transobturator outside-in technique. Results: the use of self-tailored polypropylene mesh is possible for using as sub-urethral sling for urinary incontinence. In addition, it can be used for the transobturator cystocele synthetic repair. A 15/15 cm mesh was sufficient for both repairs. No infectious complication or mesh erosion was noted. The great benefit of this self-tailored mesh is the economic gain since it is at least 6-times cheaper than the manufactured ones. Moreover, in this case one single mesh is used instead of 2, to treat both pathologies. Conclusion: the use of a self-tailored mesh is possible, and safe for the transobturator repair of stress urinary incontinence and cystocele synthetic repair. In addition it has a real economic benefit compared to the usual meshes.