Aim of Study:
To demonstrate a vaginal approach to improve the support of anterior compartment prolapse (ACP) after failed cystocele repair with the interposition of Prolene GyneMesh (polypropylene mesh).

Methods:
All patients underwent multichannel urodynamics with their prolapse reduced to ensure there is no concomitant stress urinary incontinence. The patient is placed in a modified lithotomy position using Allen stirrups. The vagina is cleansed with betadine solution and draped in a sterile conventional manner. The midline of the anterior vaginal wall (AVW) is infused with 10 ml of 1 % lidocaine with 1:200000 adrenaline solution. The AVW is incised vertically one centimeter proximal to the external urethral meatus. The cystocele is mobilised and reduced. A 1-0 vicryl stitch is placed at the bladder neck (Kelly suture). The mesh is trimmed to adequately reduce the cystocele. A series of 2-0 vicryl stitches incorporate pubocervical fascia and the mesh. Redundant AVW is excised. The AVW is closed with continuous locking 1-0 vicryl suture. The bladder is drained with a Bonnano suprapubic catheter for 24-48 hours.

Result:
This vaginal procedure provides excellent and expedient reduction of recurrent cystocele. With one year's experience we have not encountered any recurrent cystocele, urethral or bladder injury, mesh erosion, de novo urgency or urinary retention.

Conclusion:
SCR with polypropylene mesh provides excellent reduction of a cystocele.