Long-term (8.5 years) analysis of the type and rate of reoperation after transvaginal mesh repair (Prolift ®) in 349 patients

Eur J Obstet Gynecol Reprod Biol. 2019 Jan;232:33-39. doi: 10.1016/j.ejogrb.2018.10.009. Epub 2018 Oct 6.

Abstract

Objective: Polypropylene meshes have specific complications, and in 2016 the Food and Drug Administration required a Premarket Approval for their use in pelvic prolapse repair, as there was a lack of long-term data. Our objectives were to determine the long-term reoperation rates and type in our patients after transvaginal mesh repair and to study their risk factors.

Study design: We were able to follow up with 349 patients from a single University Hospital, with phone calls, after a median time of 8,5 years. The 8.5-year reoperation rates were derived from Kaplan-Meier survival curves.

Results: Our global, long-term reoperation rate, including mesh complications, prolapse recurrence and urinary incontinence after a median follow-up of 8.5 years, was 14.5%. The mesh-related complication rate (including mesh exposures, infections, and retractions requiring surgery) was 4.3%, the urinary incontinence rate was 5.7%. The prolapse recurrence rate was 7.2%; mainly found with posterior mesh only (18.5% of reoperations). For total Prolift, the reoperation rate for prolapse recurrence was only 4%. Moreover, 867% of the patients who had an anterior Prolift only or a posterior Prolift only and who were re-operated for prolapse recurrence showed recurrence exclusively in another compartment. In bivariate analysis, only the posterior mesh type was significantly associated with prolapse recurrence versus total meshes.

Conclusion: Despite their market withdrawal, the transvaginal meshes are a safe and efficient option for pelvic organ prolapse surgical management. Low rates of mesh complications can be achieved with cautious dissection and adequate training of surgeons.

Keywords: Exposure; Mesh; POP (pelvic organ prolapse); Prolift; Recurrence.

MeSH terms

  • Aged
  • Female
  • Gynecologic Surgical Procedures / statistics & numerical data*
  • Humans
  • Middle Aged
  • Pelvic Organ Prolapse / surgery*
  • Recurrence
  • Reoperation / statistics & numerical data
  • Retrospective Studies
  • Surgical Mesh