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Long-term outcome after transvaginal mesh repair of pelvic organ prolapse

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Abstract

Introduction and hypothesis

The aim of this study was to report long-term subjective and objective outcomes after the transvaginal mesh (TVM) procedure in long-term. Possible late-onset complications were of particular interest.

Methods

This was a retrospective analysis of TVM performed using Prolift™ transvaginal mesh measuring subjective outcome using validated questionnaires. Objective outcome was assessed using the Pelvic Organ Prolapse Quantification (POP-Q) system using two definitions: POP-Q stage ≤ 1, and vaginal wall prolapse at or above the hymen or vaginal apex not descending below the upper third of the vagina. Complications were reported with the Prosthesis/Graft Complication Classification Code designed by the International Continence Society/International Urogynecological Association (ICS/IUGA).

Results

Of 195 patients, 161 (82.6 %) participated this study after a median of 7 years. The scores in questionnaires evaluating urinary (UI) or anal incontinence and constipation or pelvic floor symptoms were low, indicating favorable surgical outcomes. Altogether, 80.1 % of patients were satisfied with the procedure. Anatomical cure was 56.4 % and 69.3 % depending on the definition used. Reoperation due to POP in any compartment was performed in 16.2 % of patients. Mesh exposure rate was 23 %, most of these being asymptomatic and of late onset.

Conclusions

Outcome of the TVM procedure was satisfactory. Anatomical cure was inferior to subjective cure. Mesh exposure rate was high; most exposures observed in the long-term were of late onset and were asymptomatic.

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Abbreviations

POP:

Pelvic organ prolapse

SCP:

Sacrocolpopexy

FDA:

Food and Drug Administration

TVM:

Transvaginal mesh

UISS:

Urinary Incontinence Severity Score

DIS:

Detrusor Instability Score

VAS:

Visual Analog Scale

POPDI-6:

Pelvic Organ Prolapse Distress Inventory

EQ-5D:

EuroQoL-5D

PISQ-12:

Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire

POP-Q:

Pelvic Organ Prolapse Quantification

ICS:

International Continence Society

IUGA:

International Urogynecological Association

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Acknowledgments

Jaakko Matomäki, MSc, for performing statistical analysis.

This work was funded by University of Turku and Finnish Medical Foundation.

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland

    Pia Heinonen, Riikka Aaltonen, Kirsi Joronen & Seija Ala-Nissilä

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  1. Pia Heinonen
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  2. Riikka Aaltonen
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  3. Kirsi Joronen
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  4. Seija Ala-Nissilä
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Correspondence to Pia Heinonen.

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Heinonen, P., Aaltonen, R., Joronen, K. et al. Long-term outcome after transvaginal mesh repair of pelvic organ prolapse. Int Urogynecol J 27, 1069–1074 (2016). https://doi.org/10.1007/s00192-015-2939-7

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  • DOI: https://doi.org/10.1007/s00192-015-2939-7

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