title: Retrospective study of tension-free vaginal mesh operation outcomes for prognosis improvement.
abstract: OBJECTIVE
  The aim of this study is to look at the weak points of tension-free vaginal mesh (TVM) operation for pelvic organ prolapse by reviewing recurrent cases.
  
  
  METHODS
  Five hundred and twenty-six transobturator TVM operations were performed at the University of Occupational and Environmental Health hospital from August 2006 to December 2011. Thirty-seven patients with pelvic organ prolapse quantification (POP-Q) stage II or higher after their initial operations were diagnosed as recurrent and were enrolled in the present study. The patients' characteristics, procedures of the initial and second operations, and the recurrence rates in the pelvic organs were retrospectively reviewed.
  
  
  RESULTS
  The median age, parity and body mass index of the patients were 66.5 years (range, 48-80), 2.2-times (range, 1-5) and 24.1 kg/m(2) (range, 17.6-32.1), respectively. The mean/median follow-up periods of the whole group were 29.7/35.9 months and the recurrent prolapse rate was 7.0% (37/526 cases). We performed reoperations in eight cases (8/526 cases; 1.5%). The median recurrent period after the initial operations was 6.9 months (range, 1-24). All recurrent cases showed severe prolapse with POP-Q stage III to IV before the initial operations. The uterus showed the most frequent recurrent prolapse after anterior posterior TVM or anterior TVM.
  
  
  CONCLUSIONS
  Because the uterus is the most recurrent organ after TVM operations, TVM operations may not be sufficient for apical suspension.
authors.affiliation: Department of Obstetrics and Gynecology, University of Occupational and Environmental Health.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Sho
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Yoshimura
authors.forename: Toru
authors.initials: T
authors.lastname: Hachisuga
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation* / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D053825:Suburethral Slings / Q000009:adverse effects*
keywords: mesh surgery; pelvic organ prolapse; prognosis; recurrence; tension-free vaginal mesh operation