Preliminary Report on the Modified Cadaveric Anterior Prolapse and Sling (McaPS) Procedure for Correction of Anterior Vaginal Wall Defects

Drs. Terry Johnson, Simon Payne
Denver, Colorado

Objective: To determine if performance of a modified Aldridge sling procedure yields similar results to utilization of a transvaginal bone anchor sling, as originally described with the Cadaveric Anterior Prolapse and Sling (CaPS) procedure.  In addition, the study is designed to confirm the use of a combined paravaginal and suburethral sling as a useful method to correct anterior wall defects. 
Study Design :  Patients with at least Grade II anterior wall defects, with or without urinary incontinence, underwent a MCaPS procedure for correction of cystocele.  Additional procedures were done concurrently to correct other pelvic organ support defects.  The McaPS procedure was performed similarly to a CaPS procedure.  A 6x8 or 8x8cm segment of cadaveric fascia is used.  A 2cm segment is chosen for the modified Aldridge sling.  A 5mm Mersilene tape is placed at each fascial edge.  These are then brought through a small suprapubic incision and are tied at the completion of all planned prolapse procedure.  The remained of the fascia is secured to the obturator muscle and fascia in the retropubic space and the superior vaginal segment.  This forms a sling under the bladder to reduce the cystocele.
Result:  To date, 24 patients have undergone a MCaPS procedure.  Final accrual of patient will end November 15, 2001.  It is anticipated 35 patients will be included in the initial study results.  Preoperative data collection includes demographics; assessment of pelvic organ prolapse using POP-Q and/or modified Baden grading system, urodynamics in selected patients.  Postoperative data will include repeat prolapse and incontinence studies and the completion of an evaluation to assess quality of life, prolapse and incontinence symptoms. Intra and postoperative data including complications will be reported (to date, no complications have occurred).  Follow-up will be 1-9 months, similar to the original CaPS report.  Initial short-term evaluation has confirmed the success of the MCaPS procedure.
Conclusion:   Based on early results, the MCaPS procedure appears to be a valuable addition to existing techniques for the correction of anterior vaginal wall defects.  This is a preliminary report and the study will be continued to ultimately assess long-term durability and success rates.