OC29.05: Should mesh be used with anterior colporrhaphy?

Abstract

Objectives: Mesh reinforcement of anterior colporrhaphy (AC) for cystocele repair has become popular in recent years, with some evidence of reduced recurrence rates. In this case control series, we aim to compare the effect of mesh use on anatomical and functional outcomes, including imaging assessment of prolapse recurrence after AC with and without transobturator mesh augmentation. Methods: Outcomes of 183 patients after anterior vaginal prolapse repair between Jan 1998 and Oct 2008 were analysed. 83 patients had AC, 100 patients AC with transobturator mesh. Patients were assessed post-surgically with a standardised interview, ICS POP-Q clinical examination and 4D translabial ultrasound using GE Kretz Voluson 730 expert and Voluson I system. Results: Potential predictors of recurrence such as age, BMI, vaginal parity and recurrence of prolapse as defined as POPQ ≥ Stage 2 were tested. Only length of follow-up and avulsion injury were significant predictors. Consequently, to match both groups for these two parameters, 49 datasets were removed in a blinded fashion, leaving a total of 67 patients in each group for analysis. Recurrent cystocele ≥ Stage 2 was observed in 31% of mesh patients and 55% in the non-mesh group (OR 0.37 [CI 0.18–0.75] P = 0.005). The rate of recurrence was significantly higher amongst patients with levator avulsion, 36% in the mesh group compared to 78% in the non-mesh group (OR 0.16 [CI 0.04–0.59] P = 0.004). Conclusions: At 4 years follow-up, mesh augmentation was associated with less recurrence of cystocele. This effect was mainly due to reduced recurrence in women with levator avulsion.