International Urogynecology Journal

, Volume 24, Issue 8, pp 1279–1285 | Cite as

Long-term outcomes of vaginal mesh versus native tissue repair for anterior vaginal wall prolapse

  • Michele Jonsson Funk
  • Anthony G. Visco
  • Alison C. Weidner
  • Virginia Pate
  • Jennifer M. Wu
Original Article

Abstract

Introduction and hypothesis

To estimate the risk of repeat surgery for recurrent prolapse or mesh removal after vaginal mesh versus native tissue repair for anterior vaginal wall prolapse.

Methods

We utilized longitudinal, adjudicated, healthcare claims from 2005 to 2010 to identify women ≥18 years who underwent an anterior colporrhaphy (CPT 57420) with or without concurrent vaginal mesh (CPT 57267). The primary outcome was repeat surgery for anterior or apical prolapse or for mesh removal/revision; these outcomes were also analyzed separately. We utilized Kaplan–Meier curves to estimate the cumulative risk of each outcome after vaginal mesh versus native tissue repair. Cox proportional hazards models were used to estimate the hazard ratio (HR) for vaginal mesh versus native tissue repair, adjusted for age, concurrent hysterectomy, and concurrent or recent sling.

Results

We identified 27,809 anterior prolapse surgeries with 49,658 person-years of follow-up. Of those, 6,871 (24.7%) included vaginal mesh. The 5-year cumulative risk of any repeat surgery was significantly higher for vaginal mesh versus native tissue (15.2 % vs 9.8 %, p <0.0001) with a 5-year risk of mesh revision/removal of 5.9%. The 5-year risk of surgery for recurrent prolapse was similar between vaginal mesh and native tissue groups (10.4 % vs 9.3 %, p = 0.70. The results of the adjusted Cox model were similar (HR 0.93, 95%CI: 0.83, 1.05).

Conclusions

The use of mesh for anterior prolapse was associated with an increased risk of any repeat surgery, which was driven by surgery for mesh removal. Native tissue and vaginal mesh surgery had similar 5-year risks for surgery for recurrent prolapse.

Keywords

Anterior colporrhaphy Pelvic organ prolapse Surgery Recurrent prolapse Vaginal mesh 

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Copyright information

© The International Urogynecological Association 2013

Authors and Affiliations

  • Michele Jonsson Funk
    • 1
    • 2
  • Anthony G. Visco
    • 3
  • Alison C. Weidner
    • 3
  • Virginia Pate
    • 1
  • Jennifer M. Wu
    • 3
    • 4
  1. 1.Department of EpidemiologyGillings School of Global Public HealthChapel HillUSA
  2. 2.Center for Women’s Health ResearchUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.Division of Urogynecology, Department of Obstetrics and GynecologyDuke UniversityDurhamUSA
  4. 4.Duke University Medical CenterDurhamUSA

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