Outcomes after anterior vaginal wall repair with mesh: a randomized, controlled trial with a 3 year follow-up.
OBJECTIVE
The objective of the study was to compare anterior colporrhaphy with and without a mesh.


METHODS
Two hundred two women with anterior prolapse were assigned to undergo colporrhaphy alone or reinforced with a tailored polypropylene mesh. Before and 2, 12, 24, and 36 months after surgery, the outcome was assessed by examination and standard questions. The primary endpoint was anatomic recurrence of anterior vaginal prolapse. Secondary outcomes were symptom resolution, reoperation, and mesh exposure.


RESULTS
Recurrences of anterior vaginal prolapse were noted in 40 of the 97 (41%) in the colporrhaphy group and 14 of 105 (13%) in the mesh group (P < .0001). The number needed to treat was thus 4. The proportion of symptomatic patients, including those with dyspareunia, did not differ between the groups. The mesh erosion rate was 19%.


CONCLUSIONS
At 3 year follow-up, anterior colporrhaphy with mesh reinforcement significantly reduced anatomic recurrences of anterior vaginal prolapse, but no difference in symptomatic recurrence were noted and the mesh erosion rate was high. The use of mesh was not associated with an increase in dyspareunia.
Nieminen
Kari
K
Department of Obstetrics and Gynecology, Tampere University Hospital, University of Tampere, Tampere, Finland. kari.nieminen@pshp.fi
Hiltunen
Reijo
R
Takala
Teuvo
T
Heiskanen
Eila
E
Merikari
Mauri
M
Niemi
Kirsti
K
Heinonen
Pentti K
PK
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures; D006801:Humans; D011126:Polypropylenes; D011183:Postoperative Complications; D011446:Prospective Studies; D012086:Reoperation; D055502:Secondary Prevention; D012725:Sexual Behavior; D013526:Surgical Mesh / Q000009:adverse effects; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000601:surgery; D014596:Uterine Prolapse / Q000517:prevention & control / Q000601:surgery*; D014621:Vagina / Q000601:surgery*
D011126:Polypropylenes