International Urogynecology Journal

, Volume 24, Issue 10, pp 1679–1686

Total transvaginal mesh (TVM) technique for treatment of pelvic organ prolapse: a 5-year prospective follow-up study

  • B. Jacquetin
  • P. Hinoul
  • J. Gauld
  • B. Fatton
  • C. Rosenthal
  • H. Clavé
  • O. Garbin
  • J. Berrocal
  • R. Villet
  • D. Salet-Lizée
  • P. Debodinance
  • M. Cosson
Original Article


Introduction and hypothesis

To evaluate clinical effectiveness and complication rates at 5 years following the total Trans Vaginal Mesh (TVM) technique to treat pelvic organ prolapse.


Prospective, observational, multi-centre study in patients with prolapse of stage II or higher.


Of the 90 women enrolled in the study, 82 (91 %) were available for the 5-year follow-up period. At the 5-year endpoint, success, defined as no surgical prolapse reintervention and leading edge <−1 (International Continence Society [ICS] criteria) or above the level of the hymen, was 79 % and 87 % respectively. A composite criterion of success defined as: leading edge above the hymen (<0) and no bulge symptoms and no reintervention for prolapse was met by 90 %, 88 % and 84 % at the 1-, 3-, and 5-year endpoints respectively. Quality of life improvement was sustained over the 5 years. Over the 5-year follow-up period, a total of only 4 patients (5 %) required re-intervention for prolapse, while a total of 14 patients (16 %) experienced mesh exposure for which 8 resections needed to be performed. Seven exposures were still ongoing at the 5-year endpoint, all asymptomatic. Only 33 out of 61 (54 %) sexually active patients at baseline remained so at 5 years. De novo dyspareunia was reported by 10 %, but no new cases at the 5-year endpoint. One patient reported de novo unprovoked mild pelvic pain at 5 years, 5 reported pains during pelvic examination only.


Five-year results indicated that TVM provided a stable anatomical repair. Improvements in QOL and associated improvements in prolapse-specific symptoms were sustained. Minimal new morbidity emerged between the 1- and 5-year follow-up.


Mesh Pelvic organ prolapse Polypropylene Prolift Transvaginal mesh Vaginal surgery 



Body mass index


International Continence Society


Last observation carried forward


Pelvic organ prolapse


Pelvic organ prolapse quantification


Prolapse-specific inventory


Quality of life


Standard deviation


Stress urinary incontinence


Transvaginal mesh


  1. 1.
    Whiteside JL, Weber AM, Meyn LA, Walters MD (2004) Risk factors for prolapse recurrence after vaginal repair. Am J Obstet Gynecol 191(5):1533–1538PubMedCrossRefGoogle Scholar
  2. 2.
    Paraiso MF, Ballard LA, Walters MD, Lee JC, Mitchinson AR (1996) Pelvic support defects and visceral and sexual function in women treated with sacrospinous ligament suspension and pelvic reconstruction. Am J Obstet Gynecol 175(6):1423–1430PubMedCrossRefGoogle Scholar
  3. 3.
    Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89(4):501–506PubMedCrossRefGoogle Scholar
  4. 4.
    Fialkow MF, Newton KM, Weiss NS (2008) Incidence of recurrent pelvic organ prolapse 10 years following primary surgical management: a retrospective cohort study. Int Urogynecol J Pelvic Floor Dysfunct 19(11):1483–1487PubMedCrossRefGoogle Scholar
  5. 5.
    Soderberg MW, Falconer C, Bystrom B, Malmstrom A, Ekman G (2004) Young women with genital prolapse have a low collagen concentration. Acta Obstet Gynecol Scand 83:1193–1198PubMedGoogle Scholar
  6. 6.
    Jackson SR, Avery NC, Tarlton JF, Eckford SD, Abrams P, Bailey AJ (1996) Changes in metabolism of collagen in genitourinary prolapse. Lancet 347:1658–1661PubMedCrossRefGoogle Scholar
  7. 7.
    Ulmsten U, Henriksson L, Johnson P, Varhos G (1996) An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 7:81–85PubMedCrossRefGoogle Scholar
  8. 8.
    Luijendijk RW, Hop WC, van den Tol MP, de Lange DC, Braaksma MM, IJzermans JN, Boelhouwer RU, de Vries BC, Salu MK, Wereldsma JC, Bruijninckx CM, Jeekel J (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343(6):392–398PubMedCrossRefGoogle Scholar
  9. 9.
    Hiltunen R, Nieminen K, Takala T, Heiskanen E, Merikari M, Niemi K, Heinonen PK (2007) Low-weight polypropylene mesh for anterior vaginal wall prolapse: a randomized controlled trial. Obstet Gynecol 110(2 Pt 2):455–462PubMedCrossRefGoogle Scholar
  10. 10.
    Sivaslioglu AA, Unlubilgin E, Dolen I (2008) A randomized comparison of polypropylene mesh surgery with site-specific surgery in the treatment of cystocoele. Int Urogynecol J Pelvic Floor Dysfunct 19(4):467–471PubMedCrossRefGoogle Scholar
  11. 11.
    Nieminen K, Hiltunen R, Heiskanen E, Takala T, Niemi K, Merikari M, Heinonen PK (2008) Symptom resolution and sexual function after anterior vaginal wall repair with or without polypropylene mesh. Int Urogynecol J Pelvic Floor Dysfunct 19(12):1611–1616PubMedCrossRefGoogle Scholar
  12. 12.
    Nguyen JN, Burchette RJ (2008) Outcome after anterior vaginal prolapse repair: a randomized controlled trial. Obstet Gynecol 111(4):891–898PubMedCrossRefGoogle Scholar
  13. 13.
    Carey M, Higgs P, Goh J, Lim J, Leong A, Krause H, Cornish A (2009) Vaginal repair with mesh versus colporrhaphy for prolapse: a randomised controlled trial. BJOG 116(10):1380–1386PubMedCrossRefGoogle Scholar
  14. 14.
    Nieminen K, Hiltunen R, Takala T, Heiskanen E, Merikari M, Niemi K, Heinonen PK (2010) Outcomes after anterior vaginal wall repair with mesh: a randomized, controlled trial with a 3 year follow-up. Am J Obstet Gynecol 203(3):235.e1–235.e8CrossRefGoogle Scholar
  15. 15.
    Withagen MI, Milani AL, den Boon J, Vervest HA, Vierhout ME (2011) Trocar-guided mesh compared with conventional vaginal repair in recurrent prolapse: a randomized controlled trial. Obstet Gynecol 117(2 Pt 1):242–250PubMedCrossRefGoogle Scholar
  16. 16.
    Altman D, Väyrynen T, Engh ME, Axelsen S, Falconer C, Nordic Transvaginal Mesh Group (2011) Anterior colporrhaphy versus transvaginal mesh for pelvic-organ prolapse. N Engl J Med 364(19):1826–1836PubMedCrossRefGoogle Scholar
  17. 17.
    Sokol AI, Iglesia CB, Kudish BI, Gutman RE, Shveiky D, Bercik R, Sokol ER (2012) One-year objective and functional outcomes of a randomized clinical trial of vaginal mesh for prolapse. Am J Obstet Gynecol 206(1):86.e1–86.e9CrossRefGoogle Scholar
  18. 18.
    Jacquetin B, Fatton B, Rosenthal C, Clavé H, Debodinance P, Hinoul P, Gauld J, Garbin O, Berrocal J, Villet R, Salet Lizée D, Cosson M (2010) Total transvaginal mesh (TVM) technique for treatment of pelvic organ prolapse: a 3-year prospective follow-up study. Int Urogynecol J Pelvic Floor Dysfunct 21:1455–1462CrossRefGoogle Scholar
  19. 19.
    Bump RC, Mattiasson A, Bø K, Brubaker LP, DeLancey JO, Klarskov P, Shull BL, Smith AR (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175(1):10–17PubMedCrossRefGoogle Scholar
  20. 20.
    Kobashi KC, Gormley EA, Govier F, Hadley R, Luber K, Nitti V (2000) Development of a validated quality of life measurement for patients with pelvic prolapse. Proceedings of the American Urological Association 95th Annual Meeting. J Urol 163:76Google Scholar
  21. 21.
    Barber MD, Brubaker L, Nygaard I, Wheeler TL 2nd, Schaffer J, Chen Z, Spino C (2009) Pelvic floor disorders network. Defining success after surgery for pelvic organ prolapse. Obstet Gynecol 114(3):600–609PubMedCrossRefGoogle Scholar
  22. 22.
    Clark AL, Gregory T, Smith VJ, Edwards R (2003) Epidemiologic evaluation of reoperation for surgically treated pelvic organ prolapse and urinary incontinence. Am J Obstet Gynecol 189:1261–1267PubMedCrossRefGoogle Scholar
  23. 23.
    Benson JT, Lucente V, McClellan E (1996) Vaginal versus abdominal reconstructive surgery for the treatment of pelvic support defects: a prospective randomized study with long-term outcome evaluation. Am J Obstet Gynecol 175:1418–1422PubMedCrossRefGoogle Scholar
  24. 24.
    FDA Safety communication: update on serious complications associated with transvaginal mesh placement of surgical mesh for pelvic organ prolapse, FDA, July 13, 2011
  25. 25.
    Miller D, Lucente V, Babin E, Beach P, Jones P, Robinson D (2011) Prospective clinical assessment of the transvaginal mesh technique for treatment of pelvic organ prolapse-5-year results. Female Pelvic Med Reconstr Surg 17(3):139–143PubMedCrossRefGoogle Scholar
  26. 26.
    Diwadkar GB, Barber MD, Feiner B, Maher C, Jelovsek JE (2009) Complication and reoperation rates after apical vaginal prolapse surgical repair: a systematic review. Obstet Gynecol 113(2 Pt 1):367–373PubMedGoogle Scholar
  27. 27.
    Abed H, Rahn DD, Lowenstein L, Balk EM, Clemons JL, Rogers RG (2011) Incidence and management of graft erosion, wound granulation, and dyspareunia following vaginal prolapse repair with graft materials: a systematic review. Int Urogynecol J 22(7):789–798PubMedCrossRefGoogle Scholar
  28. 28.
    Tijdink MM, Vierhout ME, Heesakkers JP, Withagen MI (2011) Surgical management of mesh-related complications after prior pelvic floor reconstructive surgery with mesh. Int Urogynecol J 22(11):1395–1404PubMedCrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2013

Authors and Affiliations

  • B. Jacquetin
    • 1
    • 11
  • P. Hinoul
    • 2
  • J. Gauld
    • 3
  • B. Fatton
    • 1
  • C. Rosenthal
    • 4
  • H. Clavé
    • 5
  • O. Garbin
    • 6
  • J. Berrocal
    • 7
  • R. Villet
    • 8
  • D. Salet-Lizée
    • 8
  • P. Debodinance
    • 9
  • M. Cosson
    • 10
  1. 1.Department of Obstetrics and GynaecologyEstaing University HospitalClermont-FerrandFrance
  2. 2.Medical Affairs, EthiconSomervilleUSA
  3. 3.Clinical Development, EthiconLivingstonUK
  4. 4.Department of GynaecologySaint Germain Private HospitalBrive La GaillardeFrance
  5. 5.Department of GynaecologySaint George Private ClinicNiceFrance
  6. 6.Department of Obstetrics and GynaecologySIHCUS-CMCO University HospitalStrasbourgFrance
  7. 7.Department of GynaecologyL’Europe Private ClinicRouenFrance
  8. 8.Department of GynaecologyDiaconesses HospitalParisFrance
  9. 9.Department of Obstetrics and GynaecologyGeneral Hospital DunkerqueDunkirkFrance
  10. 10.Department of Obstetrics and GynaecologyJeanne de Flandre University HospitalLilleFrance
  11. 11.Department of Obstetrics-Gynaecology-Human ReproductionEstaing University HospitalClermont Ferrand Cedex 1France

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