Abstract
ObjectiveTo compare vaginal repair augmented by mesh with traditional colporrhaphy for the treatment of pelvic organ prolapse.DesignProspective randomised controlled trial.SettingTertiary teaching hospital.PopulationOne hundred and thirty-nine women with stage ≥2 prolapse according to the pelvic organ prolapse quantification (POP-Q) system requiring both anterior and posterior compartment repair.MethodsSubjects were randomised to anterior and posterior vaginal repair with mesh augmentation (mesh group, n= 69) or traditional anterior and posterior colporrhaphy (no mesh group, n= 70).Main outcome measuresThe primary outcome was the absence of POP-Q stage ≥2 prolapse at 12 months. Secondary outcomes were symptoms, quality-of-life outcomes and satisfaction with surgery. Complications were also reported.ResultsFor subjects attending the 12-month review, success in the mesh group was 81.0% (51 of 63 subjects) compared with 65.6% (40/61) in the no mesh group and was not significantly different (P-value = 0.07). A high level of satisfaction with surgery and improvements in symptoms and quality-of-life data were observed at 12 months compared to baseline in both groups, but there was no significant difference in these outcomes between the two groups. Vaginal mesh exposure occurred in four women in the mesh group (5.6%). De novo dyspareunia was reported by five of 30 (16.7%) sexually active women in the mesh group and five of 33 (15.2%) in the no mesh group at 12 months.ConclusionIn this study, vaginal surgery augmented by mesh did not result in significantly less recurrent prolapse than traditional colporrhaphy 12 months following surgery.
Highlights
In the United States, 200 000 women undergo surgery annually for pelvic organ prolapse.[1,2] Combined anterior and posterior colporrhaphy was performed on 35.2% women undergoing prolapse surgery in 2003 and was the most common operation for this condition.[2]
Dissatisfaction with traditional colporrhaphy for pelvic organ prolapse has resulted in increased use of mesh to augment vaginal repair procedures to obtain higher success rates
Women recommended vaginal surgery for anterior and posterior vaginal wall prolapse with stage 2 or more prolapse according to the pelvic-organ-prolapse quantification (POP-Q) system were invited to participate in this study.[9]
Summary
In the United States, 200 000 women undergo surgery annually for pelvic organ prolapse.[1,2] Combined anterior and posterior colporrhaphy was performed on 35.2% women undergoing prolapse surgery in 2003 and was the most common operation for this condition.[2]. Dissatisfaction with traditional colporrhaphy for pelvic organ prolapse has resulted in increased use of mesh to augment vaginal repair procedures to obtain higher success rates. The use of mesh during vaginal repair procedures is controversial. Uncontrolled studies have reported significant problems (e.g. dyspareunia and mesh exposure) with the use of mesh during vaginal prolapse surgery.[4,5] By contrast, there is wide acceptance of mesh use for prolapse with the abdominal sacral colpopexy procedure.[6,7,8]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: BJOG: An International Journal of Obstetrics & Gynaecology
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
