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Assessing pelvic organ prolapse recurrence after minimally invasive sacrocolpopexy: does mesh weight matter?

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Abstract

Introduction and hypothesis

There has been a trend toward the use of ultra-lightweight mesh types for minimally invasive sacrocolpopexy. We hypothesized that ultra-lightweight mesh would have a greater proportion of composite anatomical pelvic organ prolapse recurrence than lightweight mesh.

Methods

Retrospective cohort study of minimally invasive sacrocolpopexies at two academic institutions from 2009 to 2016. Our primary outcome was composite anatomical prolapse recurrence, defined as prolapse beyond the hymen or retreatment with pessary or surgery, compared between ultra-lightweight (≤21 g/m2 [range 19–21]) and lightweight (>21 g/m2 [range 35–50]) mesh types. We assessed time to prolapse recurrence using Kaplan–Meier and Cox regression.

Results

The cohort consisted of 1,272 laparoscopic (n = 530, 41.7%) and robotic-assisted sacrocolpopexies (n = 742, 58.4%). Lightweight mesh was used in 745 procedures (58.6%) and ultra-lightweight mesh in 527 (41.4%). The lightweight mesh had longer median follow-up than the ultra-lightweight group (344 [IQR 50–670] vs 143 days [IQR 44–379], p < 0.01). There was no difference in composite anatomical prolapse recurrence between lightweight and ultra-lightweight mesh (54 [7.2%] vs 35 [6.6%], p = 0.68). Ultra-lightweight mesh demonstrated a shorter time to prolapse recurrence (p < 0.01), which remained significant on multivariate Cox regression (HR 2.38 [95% CI 1.47–3.87]). The lightweight mesh had significantly more mesh complications (43 [5.8%] vs 7 [1.3%], p < 0.01).

Conclusions

Ultra-lightweight mesh for minimally invasive sacrocolpopexy was not associated with a higher proportion of composite anatomical prolapse recurrence; however, it was associated with a shorter time to recurrence. Longer follow-up is needed to assess the clinical importance of this finding, particularly given the trade-off of more complications with lightweight mesh.

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Authors and Affiliations

  1. Urogynecology and Pelvic Floor Reconstructive Surgery, Magee-Womens Hospital of UPMC, University of Pittsburgh School of Medicine, 300 Halket Street, PA, 15213, Pittsburgh, USA

    Lauren E. Giugale & Megan S. Bradley

  2. University of Pittsburgh, Pittsburgh, PA, USA

    Molly M. Hansbarger

  3. Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, UNC School of Medicine, Chapel Hill, NC, USA

    Amy L. Askew

  4. Duke University Medical Center, Durham, NC, USA

    Anthony G. Visco

  5. Trinity Health Of New England, Hartford, CT, USA

    Jonathan P. Shepherd

Authors
  1. Lauren E. Giugale
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  2. Molly M. Hansbarger
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  3. Amy L. Askew
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  4. Anthony G. Visco
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  5. Jonathan P. Shepherd
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  6. Megan S. Bradley
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Contributions

L.E. Giugale: project development, data collection/management/analysis, manuscript writing; M.M. Hansbarger: project development, data collection, manuscript editing; A.L. Askew: project development, data collection, manuscript editing; A.G. Visco: project development, manuscript editing; J.P. Shepherd: project development, data collection, manuscript editing; M.S. Bradley: project development, data management, data analysis, manuscript writing.

Corresponding author

Correspondence to Lauren E. Giugale.

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Author Dr. Anthony Visco discloses stock ownership in NinoMed™. The remaining authors report no conflicts of interest.

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Giugale, L.E., Hansbarger, M.M., Askew, A.L. et al. Assessing pelvic organ prolapse recurrence after minimally invasive sacrocolpopexy: does mesh weight matter?. Int Urogynecol J 32, 2195–2201 (2021). https://doi.org/10.1007/s00192-021-04681-6

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  • DOI: https://doi.org/10.1007/s00192-021-04681-6

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