title: The use of transvaginal synthetic mesh for anterior vaginal wall prolapse repair: a randomized controlled trial.
abstract: OBJECTIVE
  The aim of the study was to compare the efficacy and safety of transvaginal trocar-guided polypropylene mesh insertion with traditional colporrhaphy for treatment of anterior vaginal wall prolapse.
  
  
  METHODS
  This is a randomized controlled trial in which women with advanced anterior vaginal wall prolapse, at least stage II with Ba ≥ +1 cm according to the Pelvic Organ Prolapse Quantification (POP-Q) classification, were randomly assigned to have either anterior colporrhaphy (n = 39) or repair using trocar-guided transvaginal mesh (n = 40). The primary outcome was objective cure rate of the anterior compartment (point Ba) assessed at the 12-month follow-up visit, with stages 0 and I defined as anatomical success. Secondary outcomes included quantification of other vaginal compartments (POP-Q points), comparison of quality of life by the prolapse quality of life (P-QOL) questionnaire, and complication rate between the groups after 1 year. Study power was fixed as 80% with 5% cutoff point (p < 0.05) for statistical significance.
  
  
  RESULTS
  The groups were similar regarding demographic and clinical preoperative parameters. Anatomical success rates for colporrhaphy and repair with mesh placement groups were 56.4 vs 82.5% (95% confidence interval 0.068-0.54), respectively, and the difference between the groups was statistically significant (p = 0.018). Similar total complication rates were observed in both groups, with tape exposure observed in 5% of the patients. There was a significant improvement in all P-QOL domains as a result of both procedures (p < 0.001), but they were not distinct between groups (p > 0.05).
  
  
  CONCLUSIONS
  Trocar-guided transvaginal synthetic mesh for advanced anterior POP repair is associated with a higher anatomical success rate for the anterior compartment compared with traditional colporrhaphy. Quality of life equally improved after both techniques. However, the trial failed to detect differences in P-QOL scores and complication rates between the groups.
authors: Sector of Urogynecology and Vaginal Surgery, Department of Gynecology, Federal University of São Paulo, Rua Joaquim Floriano, 871 cj 92, São Paulo, SP, Brazil, 04534-000, delroy@terra.com.br.
authors: Carlos A
authors: CA
authors: Delroy
authors: Rodrigo de A
authors: Rde A
authors: Castro
authors: Márcia M
authors: MM
authors: Dias
authors: Paulo C
authors: PC
authors: Feldner
authors: Maria Augusta T
authors: MA
authors: Bortolini
authors: Manoel J B C
authors: MJ
authors: Girão
authors: Marair G F
authors: MG
authors: Sartori
mesh_terms: D000368:Aged; D001938:Brazil / Q000453:epidemiology; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation*; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D013526:Surgical Mesh; D016896:Treatment Outcome
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