Skip to main content

Advertisement

Log in

Are Recurrence Rates for “Traditional” Transvaginal Prolapse Repairs Really that High? What Does the Evidence Show?

  • Female Urology (H Goldman, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Pelvic organ prolapse (POP) is a common and bothersome condition. Multiple methods for surgical repair exist, and much attention has been given to improving the efficacy of repair by implementing mesh interposition. Standard (native tissue-based) repairs in the anterior compartment have long been thought to be associated with high anatomical recurrence rates and the currently available randomized controlled trials (RCTs) support this thinking. However, subjective improvement in pelvic pressure and bulging and quality of life indices are similarly improved in both standard and mesh-augmented repairs. No RCTs are available to compare standard and mesh-augmented repairs in the posterior compartment. Despite the presence of RCTs, the data is often inconsistent and questions remain regarding the optimal criteria to describe POP recurrence. While there is a role for both types of repair, the optimal patient scenario is not known.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •Of importance ••Of major importance

  1. Davila GW, Drutz H, Deprest J. Clinical implications of the biology of grafts: conclusions of the 2005 IUGA Grafts Roundtable. Int Urogynecol J. 2006;17:S51–5.

    Article  Google Scholar 

  2. Olsen AL, Smith VJ, Bergstrom JO, et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89:501–6.

    Article  PubMed  CAS  Google Scholar 

  3. Wu JM, Hundley AF, Fulton RG, Myers ER. Forecasting the prevalence of pelvic floor disorders in U.S. women: 2010 to 2050. Obstet Gynecol. 2009;114:1278–83.

    Article  PubMed  Google Scholar 

  4. Wein AJ. Voiding function and dysfunction, bladder physiology and pharmacology, and female urology. J Urol. 2011;186:2328–30.

    Article  Google Scholar 

  5. Luber KM, Boero S, Choe JY. The demographics of pelvic floor disorders: current observations and future projections. Am J Obstet Gynecol. 2001;184:1496–501.

    Article  PubMed  CAS  Google Scholar 

  6. Delancey JOL. Anatomic aspects of vaginal eversion after hysterectomy. Am J Obstet Gynecol. 1992;166:1717–24.

    Article  PubMed  CAS  Google Scholar 

  7. Dmochowski RR, Gomelsky A. Cystocele and anterior vaginal prolapse. In: Graham SD, Glenn JF, Keane TE, editors. Glenn’s urologic surgery. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2004. p. 339–48.

    Google Scholar 

  8. Kovac SR, Stubbs JT. Repair of the anterior segment. In: Kovac SR, Zimmerman CW, editors. Advances in reconstructive vaginal surgery. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 187–98.

    Google Scholar 

  9. Zimmerman CW. Posterior vaginal reconstruction with bilateral vaginal uterosacral colpopexy. In: Kovac SR, Zimmerman CW, editors. Advances in reconstructive vaginal surgery. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 199–210.

    Google Scholar 

  10. Cundiff GW, Weidner AC, Visco AG, et al. An anatomic and functional assessment of the discrete defect rectocele repair. Am J Obstet Gynecol. 1998;179:1451–6.

    Article  PubMed  CAS  Google Scholar 

  11. Clark AL, Gregory T, Smith VJ, Edwards R. Epidemiologic evaluation of reoperation for surgically treated pelvic organ prolapse and urinary incontinence. Am J Obstet Gynecol. 2003;189:1261–7.

    Article  PubMed  Google Scholar 

  12. Shull BL, Capen CV, Riggs MW, Kuehl TJ. Preoperative and postoperative analysis of site-specific pelvic support defects in 81 women treated with sacrospinous ligament suspension and pelvic reconstruction. Am J Obstet Gynecol. 1992;166:1764–71.

    Article  PubMed  CAS  Google Scholar 

  13. Paraiso MF, Ballard LA, Walters MD, et al. Pelvic support defects and visceral and sexual function in women treated with sacrospinous ligament suspension and pelvic reconstruction. Am J Obstet Gynecol. 1996;175:1423–31.

    Article  PubMed  CAS  Google Scholar 

  14. Maher C, Baessler K. Surgical management of anterior vaginal wall prolapse: an evidence based literature review. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17:195–201.

    Article  PubMed  Google Scholar 

  15. Kenton K, Shott S, Brubaker L. Outcome after rectovaginal fascia reattachment for rectocele repair. Am J Obstet Gynecol. 1999;181:1360–3.

    Article  PubMed  CAS  Google Scholar 

  16. Singh K, Cortes E, Reid WM. Evaluation of the fascial technique for surgical repair of the isolated posterior vaginal wall prolapse. Obstet Gynecol. 2003;101:320–4.

    Article  PubMed  CAS  Google Scholar 

  17. Maher CF, Qatawneh A, Baessler K, Schluter PJ. Midline rectovaginal fascial plication for repair of rectocele and obstructed defecation. Obstet Gynecol. 2004;104:685–9.

    Article  PubMed  Google Scholar 

  18. Jia X, Glazener C, Mowatt G, et al. Efficacy and safety of using mesh or grafts in surgery for anterior and/or posterior vaginal wall prolapse: systematic review and meta-analysis. BJOG. 2008;115:1350–61.

    Article  PubMed  CAS  Google Scholar 

  19. Sung VW, Rogers RG, Schaffer JI, et al. Graft use in transvaginal pelvic organ prolapse repair: a systematic review. Obstet Gynecol. 2008;112:1131–42.

    Article  PubMed  Google Scholar 

  20. •• Maher C, Feiner B, Baessler K, Glazener CMA. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2010;4:CD004014. Meta-analysis of RCTs comparing standard and mesh-augmented repairs. Manuscript includes studies in both abstract and full-publication format.

    PubMed  Google Scholar 

  21. Nguyen JN, Burchette RJ. Outcome after anterior vaginal prolapse repair: a randomized controlled trial. Obstet Gynecol. 2008;111:891–8.

    Article  PubMed  Google Scholar 

  22. Sivaslioglu AA, Unlubilgin E, Dolen I. A randomized comparison of polypropylene mesh surgery with site-specific surgery in the treatment of cystocoele. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:467–71.

    Article  PubMed  CAS  Google Scholar 

  23. Carey M, Higgs P, Goh J, et al. Vaginal repair with mesh versus colporrhaphy for prolapse: a randomised controlled trial. BJOG. 2009;116:1380–6.

    Article  PubMed  CAS  Google Scholar 

  24. Lunardelli JL, Auge AP, Lemos NL, et al. Polypropylene mesh vs. site-specific repair in the treatment of anterior vaginal wall prolapse: preliminary results of a randomized clinical trial. Rev Col Bras Cir. 2009;36:210–6.

    Article  PubMed  Google Scholar 

  25. Iglesia CB, Sokol AI, Sokol ER, et al. Vaginal mesh for prolapse: a randomized controlled trial. Obstet Gynecol. 2010;116:293–303.

    Article  PubMed  Google Scholar 

  26. • Nieminen K, Hiltunen R, Takala T, et al. Outcomes after anterior vaginal wall repair with mesh: a randomized, controlled trial with a 3 year follow-up. Am J Obstet Gynecol. 2010;203:235.e1–8. Comparison with the longest minimum follow-up (36 months). The majority of the other studies present ≤12 month follow-up.

    Article  Google Scholar 

  27. • Altman D, Väyrynen T, Engh ME, et al. Anterior colporrhaphy versus transvaginal mesh for pelvic-organ prolapse. N Engl J Med. 2011;364:1826–36. Largest RCT to date, showing a significant improvement in primary outcome after mesh-augmented repair (composite POP-Q Stage ≤1 and subjective absence of symptoms of vaginal bulging) compared with standard repair.

    Article  PubMed  CAS  Google Scholar 

  28. Menefee SA, Dyer KY, Lukacz ES, et al. Colporrhaphy compared with mesh or graft-reinforced vaginal paravaginal repair for anterior vaginal wall prolapse. Obstet Gynecol. 2011;118:1337–44.

    Article  PubMed  Google Scholar 

  29. Vollebregt A, Fischer K, Gietelink D, van der Vaart CH. Primary surgical repair of anterior vaginal prolapse: a randomised trial comparing anatomical and functional outcome between anterior colporrhaphy and trocar-guided transobturator anterior mesh. BJOG. 2011;118:1518–27.

    Article  PubMed  CAS  Google Scholar 

  30. Withagen MI, Milani AL, den Boon J, et al. Trocar-guided mesh compared with conventional vaginal repair in recurrent prolapse: a randomized controlled trial. Obstet Gynecol. 2011;117:242–50.

    Article  PubMed  Google Scholar 

  31. El-Nazer MA, Gomaa IA, Ismail Madkour WA, et al. Anterior colporrhaphy versus repair with mesh for anterior vaginal wall prolapse: a comparative clinical study. Arch Gynecol Obstet. 2012;286:965–72.

    Article  PubMed  CAS  Google Scholar 

  32. Sokol AI, Iglesia CB, Kudish BI, et al. One-year objective and functional outcomes of a randomized clinical trial of vaginal mesh for prolapse. Am J Obstet Gynecol. 2012;206:86.e1–9.

    Article  Google Scholar 

  33. Swift S, Woodman P, O’Boyle A, et al. Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol. 2005;192:795–806.

    Article  PubMed  Google Scholar 

  34. Barber MD, Brubaker L, Nygaard I, et al. Pelvic Floor Disorders Network: defining success after surgery for pelvic organ prolapse. Obstet Gynecol. 2009;114:600–9.

    Article  PubMed  Google Scholar 

Download references

Disclosure

Dr. Alex Gomelsky reported no conflicts of interest relevant to this article.

Dr. Randy Vince reported no conflicts of interest relevant to this article.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Alex Gomelsky.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gomelsky, A., Vince, R. Are Recurrence Rates for “Traditional” Transvaginal Prolapse Repairs Really that High? What Does the Evidence Show?. Curr Urol Rep 14, 262–267 (2013). https://doi.org/10.1007/s11934-013-0314-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11934-013-0314-0

Keywords

Navigation