Long-term safety and efficacy of transvaginal mesh repair for pelvic organ prolapse

Introduction: We conducted a mono-centric cohort study to evaluate the long-term functional results and safety of transvaginal mesh (TVM) repair for pelvic organ prolapse (POP).

Methods: Between 2011 and 2013 a total of 148 patients who underwent TVM repair for POP were retrospectively enrolled. Long-term complication rates and functional outcomes were retrospectively assessed. Additionally, standardised and validated questionnaires were used prospectively for evaluation of complication rates, physical complaints and quality of life. Descriptive statistic was performed for evaluation of complications and efficacy rates. Univariate analysis by the chi²-test as well as a multivariate Cox regression analysis was conducted to predict recurrence of prolapse and mesh erosion using the variables prior hysterectomy, age, BMI, prolapse degree and anterior vs. combined mesh as predictor.

Results: The mean follow-up time was 27.2 months. Intraoperative complications occurred in 3.4% including bowel and bladder injury. Mesh erosion occurred in 2.7% whereas surgical revision was necessary only in 1.4%. No predictor for mesh erosion could be identified. A recurrent prolapse was present in 6.8% whereas only 4.7% were in need of secondary prolapse repair. Postoperative complications according to Clavien-Dindo classification ≥ III occurred in 2.8%. None of the patients developed painful mesh shrinking or fistula. An improvement of POP symptoms was reported by 84.6%. The mean postoperative vaginal pain score was 0.6 according the international index of pain.

Conclusion: The TVM repair is a safe and effective procedure for POP repair if performed by experienced surgeons and by careful patient selection.