Native tissue repair or transvaginal mesh for recurrent vaginal prolapse: what are the long-term outcomes?
OBJECTIVE
The objective of this study was to assess outcomes in native tissue (NT) and transvaginal mesh (TVM) repair in women with recurrent prolapse.


METHODS
A retrospective two-group observational study of 237 women who underwent prolapse repair after failed NT repair in two tertiary hospitals. A primary outcome of "success" was defined using a composite outcome of no vaginal bulge symptoms, no anatomical recurrence in the same compartment beyond the hymen (0 cm on POPQ) and no surgical re-treatment for prolapse in the same compartment. Secondary outcomes assessed included re-operation for prolapse in the same compartment, dyspareunia and mesh-related complications.


RESULTS
Of a total of 336 repairs, 196 were performed in the anterior compartment and 140 in the posterior compartment. Compared with the TVM groups, women undergoing repeat NT repair were more likely to experience anatomical recurrence (anterior 40.9 % vs 25 %, p = 0.02, posterior 25.3 % vs 7.5 %, p = 0.01), report vaginal bulge (anterior 34.1 % vs 12 %, p < 0.01, posterior 24.1 % vs 7.5 %, p 0.02) and had a higher prolapse re-operation rate (anterior 23.9 % vs 7.4 %, p < 0.01, posterior 19.5 % vs 7.5 %, p = 0.08). Using composite outcomes, the success rate was higher with TVM repair in both compartments (anterior 34.2 % vs 13.6 %, p <0.01, posterior 56.6 % vs 23.0 %, p <0.01). Re-operations for mesh exposure were 9.3 % anteriorly and 15.1 % posteriorly. Although the number of women requiring a prolapse re-operation is lower in the TVM group, the overall re-operation rate was not significantly different when procedures to correct mesh complications were included.


CONCLUSIONS
Although the success rate is better with the use of TVM for recurrent prolapse, the total re-operation rates are similar when mesh complication-related surgeries are included.
Department of Urogynaecology, Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia. owlinli@yahoo.com.
Lin Li
http://orcid.org/0000-0002-1226-1692
LL
Ow
Department of Urogynaecology, Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia.
Yik N
YN
Lim
Department of Urogynaecology, Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia.
Peter L
PL
Dwyer
Department of Urogynaecology, Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia.
Debjyoti
D
Karmakar
Department of Urogynaecology, Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia.
Christine
C
Murray
Department of Urogynaecology, Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia.
Elizabeth
E
Thomas
Monash Medical Centre, Monash, VIC, Australia.
Anna
A
Rosamilia
D000368:Aged; D004414:Dyspareunia / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000379:methods / Q000706:statistics & numerical data; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013526:Surgical Mesh / Q000706:statistics & numerical data; D013995:Time; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000601:surgery*; D014621:Vagina / Q000601:surgery*
Dyspareunia; Mesh exposure; Recurrent prolapse; Transvaginal mesh