Review of 250 Consecutive Cases of Vaginal Mesh Surgery for Genital Organ Prolapse

Abstract

Objective: The aim of the study was to assess the success and complications of vaginal mesh surgery performed in 250 successive cases. Design: This study had a retrospective design. Materials andMethods: An analysis was performed of vaginal mesh surgery for complaints of stage II or greater pelvic organ prolapse (POP) from September 2008 to November 2010. A composite score that included subjective criteria of absence of a bothersome bulge, and objective criteria based upon Pelvic Organ Prolapse–Quantification (POP-Q) stage <II and no re-interventions was used to assess treatment success. Results: Transvaginal mesh surgery was performed in 250 subjects (age: 64.40±11.26 years, body mass index [BMI]: 28.96±5.38 kg/m2) for POP. Ten (4.0%) anterior mesh surgeries, 69 (27.6%) posterior mesh surgeries, and 171(68.4%) total mesh surgeries were performed in subjects with stage II or greater degrees of prolapse. Stage II prolapse was noted in 61 (24.4%) subjects, 154 (61.6%) had stage III, and 35 (14.0%) had stage IV prolapse. The mean follow-up was 13 months, and 222 (88.8%) patients were seen at least 12 months post-surgery. The composite success score was 89.2%. Pure anatomic success based upon POP-Q<stage II was 94.1%. Mean operative time was 119.71±41.58 minutes. Mean intraoperative blood loss was 109.28±110.89 mL. There were 12 (5.4%) cases of mesh exposure in the vagina. There were no visceral injuries or mesh erosions. The incidence of de novo dyspareunia was 15.8%. Conclusions: Transvaginal mesh surgery for POP is safe and effective, with few postoperative morbidities when performed by an experienced pelvic floor surgeon. (J GYNECOL SURG 30:134)