Please select the eligibility criteria that correspond to the clinical trial below.
Title: Randomized Controlled Trial of SIS Mesh for Anterior Repair: A Pilot Study
Brief Summary: Prolapse occurs when pelvic organs drop down and cause a bulging of the tissues. An "anterior wall prolapse" occurs when the front of the vagina loses its support, and the bladder drops down and rotates into the vaginal opening. The bladder can cause a bulge out of the vagina.

One of the treatment options available is to repair the anterior wall surgically. The goals of surgery are to return the anatomy to its usual position, ensuring that all the pelvic floor organs (bladder, vagina and rectum) can function properly. The ideal surgical repair would also be long lasting.

Two surgical options are routinely performed in Calgary for repair of an anterior compartment prolapse. One option involves fixing the organs back in place using sutures. The other option uses sutures plus a mesh made of small intestine submucosa (SIS) that is already licensed for use in Canada. The SIS mesh is slowly absorbed after it is placed in the pelvic area. The investigators do not know which of these two options is the best surgical procedure. Both may have different advantages that would result in better results. This study is designed to try and find out if one of these procedures is better, and if a larger study may be needed.


Options:
A: Inclusion Criteria:

* Postmenopausal women with symptomatic anterior vaginal wall prolapse to the hymen or beyond when under strain and referred for reconstructive pelvic surgery

Exclusion Criteria:

* an apical defect indicating concomitant vaginal fixation, or stress urinary incontinence necessitating surgery, or her main symptomatic prolapse component was in the posterior vaginal wall.
B: Inclusion Criteria:

* All patiAll patients who underwent surgery with the Avaulta synthetic mesh kit from 1/06 - 4/08.

Exclusion Criteria:

* Unable to give informed consent to participate
C: Inclusion Criteria:

* stage II or greater anterior vaginal prolapse requiring surgical correction
* age 21 years and older

Exclusion Criteria:

* less than Stage II anterior vaginal prolapse
* decline participation
* pregnant or contemplating future pregnancy
* prior anterior vaginal prolapse repair with biologic or synthetic graft
* active or latent systemic infection
* compromised immune system
* previous pelvic irradiation or cancer
* known hypersensitivity to polypropylene
* uncontrolled diabetes mellitus
* unable or unwilling to give valid informed consent
* unable or unwilling to comply with the protocol
* scheduled to undergo concomitant Burch colposuspension or pubovaginal sling
D: Inclusion Criteria:

* Women who require surgical correction for anterior compartment prolapse. (Concomitant surgery is permitted.)
* Point Ba of 0 or greater: that is a positive Ba, indicating that the prolapse is beyond the introitus, not within the vagina.
* Patient must consent to participate in the study.

Exclusion Criteria:

* Having an obliterative procedure (Lefort procedure or colpocleisis).
* Allergy to graft material.
* Immunocompromised.
* Previous anterior compartment repair.
* Are unable to understand English.
* Will be unavailable for follow-up.

Answer: D