Prospective analysis of transvaginal mesh hysteropexy in the treatment of uterine prolapse

Int Urogynecol J. 2021 Aug;32(8):2241-2247. doi: 10.1007/s00192-020-04590-0. Epub 2020 Nov 11.

Abstract

Introduction and hypothesis: The aim of this study was to assess the efficacy of using transvaginal mesh to correct uterine prolapse by hysteropexy.

Methods: This was a single-center, prospective study of 40 subjects with bothersome uterine prolapse. Inclusion criteria were bothersome perception of a vaginal bulge on Pelvic Floor Distress Inventory short form (PFDI-20) and having a Pelvic Organ Prolapse Quantification System (POP-Q) point C of -2 or worse. Exclusionary criteria included inability to consent, history of pelvic malignancies, or any prior prolapse repair. Eligible subjects were treated with transvaginal mesh hysteropexy between March 2016 and July 2018 for a primary outcome of composite success, which was defined by a POP-Q point C value of -2 or higher, PFDI-20 question 3 indicating no bothersome perception of prolapse, and no retreatment. Secondary outcomes included responses to condition-specific and quality-of-life questionnaires, satisfaction/regret, and complications.

Results: Transvaginal mesh hysteropexy was performed in 40 subjects. The majority (68%) had advanced stage (III/IV) uterine prolapse. At a median follow-up of 12 months, there was an 84% composite success, and considering only anatomic criteria (POP-Q point C < -1), there was a 92% success. No subject required reintervention for recurrent or persistent uterine prolapse. There were no cases of mesh exposures. In terms of safety, one subject required a blood transfusion for symptomatic anemia (Clavien-Dindo grade II), and one subject reported de novo dyspareunia from a perineal band that was released in office at 6 months (grade IIIa), but otherwise there were no serious immediate or late complications. There were significant improvements in both condition-specific and quality-of-life assessments from baseline. Subject satisfaction and acceptance for the procedure were high.

Conclusions: In this single-center case series of 40 women with bothersome uterovaginal prolapse, transvaginal mesh hysteropexy appears safe and effective for correcting advanced stage uterine prolapse at the short term. A future multicenter controlled trial would be needed to determine efficacy against native tissue repair.

Keywords: Hysteropexy; Pelvic organ prolapse; Transvaginal mesh; Uterine prolapse.

Publication types

  • Multicenter Study

MeSH terms

  • Female
  • Humans
  • Pelvic Organ Prolapse* / surgery
  • Prospective Studies
  • Surgical Mesh
  • Treatment Outcome
  • Uterine Prolapse* / surgery
  • Vagina

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