Postoperative indications for further surgery following post-transvaginal ProliftTM mesh repair after a two-year follow-up period: a single-centre study

Abstract

We investigated the frequency of further surgery post-artificial mesh (ProliftTM) repair of pelvic organ prolapse. In total, 257 patients who underwent ProliftTM repair were evaluated for further surgery frequency, clinical outcomes, and demographic characteristics. Thirty-eight (14.7%) patients underwent further surgery (median time to reoperation, 9.5 months; range, 6–22 months). Six (2.3%) patients underwent prolapse repair at a different (5 patients, 1.9%) or same site (1 patient, 0.3%). One underwent posterior ProliftTM repair; four, laparoscopic sacrocolpopexy; and one, vaginal hysterectomy. Eight (3.1%) underwent surgery for complications; seven (2.7%) required further surgery for mesh exposure (median, 8 months) and one (0.3%) required further surgery for mesh infection (1 month). Twenty-four (9.3%) received further surgery for stress urinary incontinence (median, 8.5 months). Despite the low frequency of further surgery post-ProliftTM repair, mesh-related complications should be considered. Careful long-term follow-up is necessary. Impact Statement What is already known on this subject? It is widely known that vaginal mesh is used as treatment for pelvic organ prolapse (POP). Vaginal mesh is one of the treatment options for POP. However, it received a bad reputation following reports of complications associated with its use, leading to discontinuation of vaginal mesh in many countries. What the results of this study revealed ? The findings of this study show that few patients who received ProliftTM repair required further surgery. The surgeries included surgery for non-POP-related conditions; subsequent surgery for stress urinary incontinence (SUI); surgery for complications including mesh exposure and infection; primary prolapse surgery for a different site and repeat surgery; and a repeat operation for prolapse arising from the same site. What are the implications of these findings in clinical practice and/or further research? Based on the outcome of this study, transvaginal ProliftTM mesh repair is a reasonably safe and effective treatment for POP. Despite withdrawal of all mesh products from the market as instructed by the FDA, this study suggested the need to re-evaluate the role of vaginal mesh as a treatment option for POP.