Efficacy and safety of transvaginal mesh kits in the treatment of prolapse of the vaginal apex: a systematic review

Abstract

Background Vaginal mesh kits are being used to surgically treat apical vaginal prolapse; however, their safety and efficacy are currently unknown.Objectives To summarise success and complication rates for commonly used vaginal mesh kits in the treatment of apical prolapse.Search strategy MEDLINE and other scientific databases were queried for primary research addressing the use of vaginal mesh kits for apical prolapse published between 1950 and 2007, including abstracts presented in major scientific meetings.Selection criteria Studies describing the use of mesh to support either the anterior or posterior compartment alone, for incontinence or fistula repair or not addressing the vaginal apex were excluded.Data collection and analysis Identified studies were grouped by the mesh kit and complications categorised using the Dindo classification system. Weighted averages and confidence intervals were calculated on objective success, follow-up length and complications.Main results Thirty studies totalling 2653 women met inclusion criteria. Objective success rates (95% CI) were ApogeeÔ (American Medical Systems Inc., Minnetonka, MN, USA) 95% (95-96), ProliftÔ (Ethicon Women's Health and Urology, Somerville, NJ, USA) 87% (86-87) and posterior intravaginal slingplasty 88% (87-89). Reoperations not requiring anaesthesia (Dindo IIIa) occurred in 0.4-2.3% and requiring anaesthesia (Dindo IIIb) in 1.5-6.0%, with a follow up between 26 and 78 weeks. Mesh erosion was the most commonly reported complication occurring in 4.6-10.7%.Author's conclusions Overall objective success using transvaginal mesh kits in restoring apical vaginal prolapse is high. However, an increasing number of women require surgical intervention for mesh-related complications based on limited data quality and short follow up. Further research addressing functional outcomes and the impact of these procedures on women's symptoms and quality of life is mandatory.

Pelvic organ prolapse transvaginal repair by the Prolift system: Evaluation of efficacy and complications after a 4.5 years follow up

“…13,14,[16][17][18][19][20][21]23 In a meta-analysis, Feiner described an exposure rate ranging from 4.6% to 10.7% for transvaginal mesh kits. 28 The previously assessed link between learning Long-term results with Prolift curve and incidence of mesh exposure 29 could explain the low incidence of erosion in the present study, where all interventions were carried out or supervised by two very experienced surgeons (FH and VD). Such a low mesh exposure rate was also reported after a median follow up of 38 months by de Landsheere et al 14 As a comparison, the long-term studies published about sacrocolpopexy report significant mesh exposure between 6 and 9%.…”

Perioperative Complications in Vaginal Mesh Procedures Using Trocar in Pelvic Organ Prolapse Repair

“…Although the use of synthetic material in prolapse surgery seems to be very effective, as supported by high cure rates, short operating and recovery time, and low recurrence rates [2][3][4][5][6][7][8], clinical experience has shown that implantation of meshes may be associated with side effects, such as pain, mesh exposures and infection, vaginal bleeding, vaginal discharge, fistulas, and dyspareunia [9][10][11][12][13][14].…”

Optimal repair of pelvic organ prolapse: the debate continues

“…A recent meta-analysis encompassing 30 studies with 2,653 patients calculated the objective success rates to be 87-95% for different kits. [29] Outcomes of standard vs. augmented POP repairs Several studies have compared the outcomes of standard and augmented anterior compartment repairs. In a 2010 Cochrane Database review, anterior colporrhaphy was associated with more recurrent cystocele formation than standard repairs augmented with polyglactin mesh or porcine dermis inlay, polypropylene mesh as an overlay, or armed transobturator mesh.…”