Is pelvic organ prolapse correction with vaginal mesh suitable with a correct indication and protocolized follow-up?


Submitted: 12 November 2021
Accepted: 25 January 2022
Published: 14 February 2022
Abstract Views: 1449
PDF: 299
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Authors

The use of vaginal mesh in order to correct Pelvic Organ Prolapse (POP) has been banned by the FDA due to the complications associated with them. The objective is to determine efficacy and safety in the short and long term in a sample of women undergoing transvaginal mesh surgery performed by properly trained surgeons, in a referral center and with a protocolized follow-up. We present a longitudinal, descriptive study of a cohort of 53 patients with POP who underwent transvaginal mesh surgery between 2001 and 2015. The efficacy of the treatment is evaluated quantifying both clinical changes and life quality, as well as the rate for prolapse recurrence and the short-and long-term treatment-related complications. A total of 53 patients with average follow-up of 87 months were included. All of them had their surgery performed by three properly-trained surgeons. Indication for mesh placement was assessed in 49.1% of cases due to previous surgery recurrence. Treatment improved urinary incontinence rates, constipation, voiding difficulty, dyspareunia and quality of life. Long-term complication rate was 9.6% (5.7% exposure, 1.9% urinary obstruction and 1.9% pain). None of the patients presented recurrence in the mesh-treated compartment and 6 patients (11.3%) needed surgery after recurrence in a different compartment at the end of follow-up. Vaginal placement of synthetic mesh for POP treatment is safe in the short-, medium- and long-term when performed in referral centers. The correct indication and long-term follow-up are essential to diagnose and treat possible complications.


Barber MD, Maher C. Epidemiology and outcome assessment of pelvic organ prolapse. Int Urogynecology J 2013;24:1783–90. DOI: https://doi.org/10.1007/s00192-013-2169-9

Weintraub AY, Glinter H, Marcus-Braun N. Narrative review of the epidemiology, diagnosis and pathophysiology of pelvic organ prolapse. Int Braz J Urol Off J Braz Soc Urol 2020;46:5–14. DOI: https://doi.org/10.1590/s1677-5538.ibju.2018.0581

Wu JM, Hundley AF, Fulton RG, Myers ER. Forecasting the prevalence of pelvic floor disorders in U.S. Women: 2010 to 2050. Obstet Gynecol 2009;114:1278–83. DOI: https://doi.org/10.1097/AOG.0b013e3181c2ce96

Cheon C, Maher C. Economics of pelvic organ prolapse surgery. Int Urogynecology J 2013;24:1873–6. DOI: https://doi.org/10.1007/s00192-013-2178-8

Mowat A, Maher D, Baessler K, et al. Surgery for women with posterior compartment prolapse. Cochrane Database Syst Rev 2018;3:CD012975. DOI: https://doi.org/10.1002/14651858.CD012975

Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev 2011;CD003882. DOI: https://doi.org/10.1002/14651858.CD003882.pub4

Chapple CR, Cruz F, Deffieux X, et al. Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence. Eur Urol 2017;72:424–31. DOI: https://doi.org/10.1016/j.eururo.2017.03.048

Kato K, Suzuki S, Hattori R. Mesh exposure after transvaginal mesh prolapse surgery: Out of permissible range? Int J Urol 2021;28:202-7. DOI: https://doi.org/10.1111/iju.14425

Duraes M, Panel L, Cornille A, Courtieu C. Long-term follow-up of patients treated by transvaginal mesh repair for anterior prolapse. Eur J Obstet Gynecol Reprod Biol 2018;230:124–9. DOI: https://doi.org/10.1016/j.ejogrb.2018.09.022

González Palanca SJ, González Veiga EJ, Palmeiro Fernández G, et al. Long-term results of genital prolapse surgery with polypropylene mesh. Actas Urol Esp 2019;43:254–61. DOI: https://doi.org/10.1016/j.acuroe.2019.04.003

Pécheux O, Giraudet G, Drumez E, et al. Long-term (8.5 years) analysis of the type and rate of reoperation after transvaginal mesh repair (Prolift®) in 349 patients. Eur J Obstet Gynecol Reprod Biol 2019;232:33–9. DOI: https://doi.org/10.1016/j.ejogrb.2018.10.009

Balchandra P, Marsh F, Landon C. Perioperative outcomes and prospective patient reported outcome measures for transvaginal mesh surgery. Arch Gynecol Obstet 2015;292:875–82. DOI: https://doi.org/10.1007/s00404-015-3724-z

de Landsheere L, Ismail S, Lucot J-P, et al. Surgical intervention after transvaginal Prolift mesh repair: retrospective single-center study including 524 patients with 3 years’ median follow-up. Am J Obstet Gynecol 2012;206:83.e1-7. DOI: https://doi.org/10.1016/j.ajog.2011.07.040

Vinchant M, Bitumba I, Letouzey V, et al. Reoperation rate and outcomes following the placement of polypropylene mesh by the vaginal route for cystocele: very long-term follow-up. Int Urogynecol J 2021;32:929-35. DOI: https://doi.org/10.1007/s00192-020-04455-6

von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008;61:344–9. DOI: https://doi.org/10.1016/j.jclinepi.2007.11.008

Haylen BT, Maher CF, Barber MD, et al. An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecology J 2016;27:165–94. DOI: https://doi.org/10.1007/s00192-015-2932-1

Patrick DL, Martin ML, Bushnell DM, et al. Quality of life of women with urinary incontinence: further development of the incontinence quality of life instrument (I-QOL). Urology 1999;53:71–6. DOI: https://doi.org/10.1016/S0090-4295(98)00454-3

Espuña Pons M, Rebollo Alvarez P, Puig Clota M. [Validation of the Spanish version of the International Consultation on Incontinence Questionnaire-Short Form. A questionnaire for assessing the urinary incontinence]. Med Clin (Barc) 2004;122:288–92. DOI: https://doi.org/10.1016/S0025-7753(04)74212-8

Musibay ER, Borges Sandrino RS. Cuestionarios de calidad de vida en las mujeres con disfunciones del suelo pélvico. Rev Cuba Obstet Ginecol 2016;42:372–85.

Pons EM, Clota PM, Aguilón GM, et al. [Questionnaire for evaluation of sexual function in women with genital prolapse and/or incontinence. Validation of the Spanish version of ‘Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12)’]. Actas Urol Esp 2008;32:211–9. DOI: https://doi.org/10.1016/S0210-4806(08)73815-4

Srikrishna S, Robinson D, Cardozo L. Validation of the Patient Global Impression of Improvement (PGI-I) for urogenital prolapse. Int Urogynecology J 2010;21:523–8. DOI: https://doi.org/10.1007/s00192-009-1069-5

Romero Maroto J, Ortiz Gorraiz M, Prieto Chaparro L, et al. TVA and TOA. New adjustable mesh for the treatment of female stress incontinence. Preliminaries results. Actas Urol Esp 2006;30:186–94. DOI: https://doi.org/10.1016/S0210-4806(06)73422-2

Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205–13. DOI: https://doi.org/10.1097/01.sla.0000133083.54934.ae

Haylen BT, Freeman RM, Swift SE, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prostheses (meshes, implants, tapes) and grafts in female pelvic floor surgery. Neurourol Urodyn 2011;30:2–12. DOI: https://doi.org/10.1002/nau.21036

Stanford EJ, Moore RD, Roovers J-PWR, et al. Elevate anterior/apical: 12-month data showing safety and efficacy in surgical treatment of pelvic organ prolapse. Female Pelvic Med Reconstr Surg 2013;19:79–83. DOI: https://doi.org/10.1097/SPV.0b013e318278cc29

Laso-García IM, Rodríguez-Cabello MA, Jiménez-Cidre MA, et al. Prospective long-term results, complications and risk factors in pelvic organ prolapse treatment with vaginal mesh. Eur J Obstet Gynecol Reprod Biol 2017;211:62–7. DOI: https://doi.org/10.1016/j.ejogrb.2017.02.005

Rudnicki M, Laurikainen E, Pogosean R, et al. A 3-year follow-up after anterior colporrhaphy compared with collagen-coated transvaginal mesh for anterior vaginal wall prolapse: a randomised controlled trial. BJOG Int J Obstet Gynaecol 2016;123:136–42. DOI: https://doi.org/10.1111/1471-0528.13628

Glazener CM, Breeman S, Elders A, et al. Mesh, graft, or standard repair for women having primary transvaginal anterior or posterior compartment prolapse surgery: two parallel-group, multicentre, randomised, controlled trials (PROSPECT). Lancet Lond Engl 2017;389:381–92. DOI: https://doi.org/10.1016/S0140-6736(16)31596-3

Altman D, Väyrynen T, Engh ME, et al. Nordic Transvaginal Mesh Group. Anterior colporrhaphy versus transvaginal mesh for pelvic-organ prolapse. N Engl J Med 2011;364:1826–36. DOI: https://doi.org/10.1056/NEJMoa1009521

Palma PCR, Monteiro MV de C, Ledesma MA, et al. Treatment of anterior vaginal wall prolapse using transvaginal anterior mesh with apical fixation: a prospective multicenter study with up to 2 years of follow-up. Int Neurourol J 2018;22:177–84. DOI: https://doi.org/10.5213/inj.1836036.018

Anglès-Acedo S, Ros-Cerro C, Escura-Sancho S, et al. Female sexuality before and after sacrocolpopexy or vaginal mesh: is vaginal length one of the key factors? Int Urogynecol J 2022;33:143-52. DOI: https://doi.org/10.1007/s00192-021-04697-y

Maher C, Feiner B, Baessler K, et al. Transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse. Cochrane Database Syst Rev 2016;2016. DOI: https://doi.org/10.1002/14651858.CD012079

MacDonald S, Terlecki R, Costantini E, Badlani G. complications of transvaginal mesh for pelvic organ prolapse and stress urinary incontinence: tips for prevention, recognition, and management. Eur Urol Focus 2016;2:260–7. DOI: https://doi.org/10.1016/j.euf.2016.06.016

Sarrio-Sanz, P., Lopez-Lopez, A. I., Martinez-Cayuelas, L., Gomez-Perez, L., Ortiz-Gorraiz, M. A., & Romero-Maroto, J. (2022). Is pelvic organ prolapse correction with vaginal mesh suitable with a correct indication and protocolized follow-up?. Urogynaecologia, 34(1). https://doi.org/10.4081/uij.2022.280

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