Author response to: Vaginal repair with mesh versus colporrhaphy for prolapse: a randomised controlled trial

Abstract

Vaginal repair with mesh versus colporrhaphy for prolapse: a randomised controlled trial Sir, We appreciate the contribution of Carey et al. 1 in the debate on the usefulness of mesh in the surgical management of vaginal prolapse. The study would have been of greater relevance had the authors solely compared traditional repair and mesh repair for vaginal prolapse. In the above study, many women had additional procedures, such as vaginal hysterectomy and repair of stress incontinence, which, by themselves, could have affected the outcomes.A larger homogeneous study population, preferably in the multicentre setting, is recommended for future studies on the optimum surgery for vaginal prolapse.As the success of interventions and their complication rates are operator dependent, the results of future evaluations should ideally be stratified by operator experience.In addition, studies need to be instituted on the optimum operative modalities for primary and subsequent repairs. Attention is also required for the evaluation of long-term postoperative outcomes. These systematic studies would help address issues on the optimum use of mesh and operators' training and mentoring needs. j Vaginal repair with mesh versus colporrhaphy for prolapse: a randomised controlled trial Authors' ReplySir, We thank Poulose and Saha for their comments. 1 When designing our study, 2 we deliberately chose to include women scheduled for a vaginal hysterectomy and antiincontinence surgery in order to improve the generalisability of the study. Recent research demonstrates that women undergoing prolapse surgery have a prevalence of concomitant hysterectomy and anti-incontinence surgery of 44% and 35.1%, respectively. 3 Our study was a randomised controlled trial. 2 The major advantage of randomisation is to control for potential confounding, with the randomisation processes evenly distributing confounders among the two treatment groups.We agree that long-term evaluation of outcomes is important. We are currently undertaking the long-term follow-up of study subjects. j