**7. Rationale for suburethral slingplasty**

The Cochrane Database of Systematic Reviews revealed that the use of mesh or graft inlays at the time of anterior vaginal wall repair may reduce the risk of recurrent anterior vaginal wall prolapse (Maher et al. 2010). The high failure rates of pelvic reconstructive procedures for anterior compartment prolapse might be a result of a decrease in the muscularis of the prolapsed vaginal tissues which impair vaginal tone and contractility (Boreham et al., 2002). Alterations in collagen, elastin, and proteoglycan proteins of the extracellular matrix within the pelvic-support ligaments and vaginal tissue might also contribute to or be associated with causes of pelvic organ prolapse or recurrence (Connell KA., 2011).

In order to reduce the high failure rate of anterior vaginal wall repair, we developed a tension free vaginal tape, using self-fashioned Gynemesh, for treating urodynamic stress incontinence and anterior vaginal wall prolapse, concomitantly. The rationale behind our suburethral slingplasty is using tension-free mesh for augmenting and enforcing the supporting layer of the urethra and bladder to treat stress urinary incontinence and anterior vaginal wall prolapse concomitantly. This procedure has provided a relatively high success rate in curing urinary incontinence (continence was 80%, improvement was 17%) and reduced the rate of recurrence of anterior vaginal wall prolapse (none with recurrent prolapse greater than stage II). As well, there was a more acceptable rate of mesh erosion (6%) when combined with other pelvic reconstructive procedures.
