Anterior Colporrhaphy versus Transvaginal Mesh for Pelvic-Organ Prolapse

Abstract

Background: The use of standardized mesh kits for repair of pelvic-organ prolapse has spread rapidly in recent years, but it is unclear whether this approach results in better outcomes than traditional colporrhaphy. Methods: In this multicenter, parallel-group, randomized, controlled trial, we compared the use of a trocarguided, transvaginal polypropylene-mesh repair kit with traditional colporrhaphy in women with prolapse of the anterior vaginal wall (cystocele). The primary outcome was a composite of the objective anatomical designation of stage 0 (no prolapse) or 1 (position of the anterior vaginal wall more than 1 cm above the hymen), according to the Pelvic Organ Prolapse Quantification system, and the subjective absence of symptoms of vaginal bulging 12 months after the surgery. Results: Of 389 women who were randomly assigned to a study treatment, 200 underwent prolapse repair with the transvaginal mesh kit and 189 underwent traditional colporrhaphy. At 1 year, the primary outcome was significantly more common in the women treated with transvaginal mesh repair (60.8%) than in those who underwent colporrhaphy (34.5%) (absolute difference, 26.3 percentage points; 95% confidence interval, 15.6 to 37.0). The surgery lasted longer and the rates of intraoperative hemorrhage were higher in the mesh-repair group than in the colporrhaphy group (P < 0.001 for both comparisons). Rates of bladder perforation were 3.5% in the mesh-repair group and 0.5% in the colporrhaphy group (P = 0.07), and the respective rates of new stress urinary incontinence after surgery were 12.3% and 6.3% (P = 0.05). Surgical reintervention to correct mesh exposure during follow-up occurred in 3.2% of 186 patients in the mesh-repair group. Conclusions: As compared with anterior colporrhaphy, use of a standardized, trocar-guided mesh kit for cystocele repair resulted in higher short-term rates of successful treatment but also in higher rates of surgical complications and postoperative adverse events. (Funded by the Karolinska Institutet and Ethicon; ClinicalTrials. gov number, NCT00566917.).

Treatment of anterior vaginal wall prolapse with and without polypropylene mesh: a prospective, randomized and controlled trial - Part I

“…Only one patient (2.3%) was submitted to partial resection of the exposed mesh and primary suture of the vaginal margins. These data are in accordance to the literature, that range from 5 to 15% (17,19,21,22). The main limit of the present study was that it was performed in a single center and did not have an independent examiner during objective evaluations at the postoperatory period.…”

A comparison of two different mesh kit systems for anterior compartment prolapse repair

“…Over the last ten years, there has been substantial change in available surgical techniques, largely due to the development of modern prolapse mesh kits. Mesh use in anterior compartment repair has been shown to be superior to traditional repair in normalising anatomy; 7 however, there are substantial disadvantages due to novel and sometimes major complications. In this current study, we tested two commonly used mesh products employing different methods of fixation.…”

“…5,6 In the last nine years, anterior compartment mesh kits have become popular due to a higher anatomical success rate, when compared with native tissue repair. 7 Mesh kits such as the Perigee TM system (American Medical Systems, Minnetonka, MN, USA) use a polypropylene mesh that is anchored to the pelvic sidewall with strip-like mesh arms that perforate through the obturator foramen. Safety and efficacy of the Perigee TM system have been documented with recent five-year data.…”

Imaging of slings and meshes

“…, 8 – 10 , 12 , 42 The probability of recurrence after cystocele repair has been shown to vary markedly from 10 to 90% between individuals 43 . Hence, the balance between risks and benefits of transvaginal mesh repairs versus traditional surgery will differ from patient to patient.…”