Synthetic Mesh May Improve Outcome of Prolapse Surgery

Researchers at the Karolinska Institutet (Stockholm, Sweden) conducted a multicenter, parallel group, randomized, and controlled trial that compared the use of a trocar-guided, transvaginal polypropylene-mesh repair kit with traditional colporrhaphy in women with prolapse of the anterior vaginal wall (cystocele). The study included 389 women with pelvic organ prolapse; of these, 200 were randomly selected for mesh surgery while the others were operated on in the conventional manner. The primary outcome was a composite of the objective anatomical designation of stage 0 (no prolapse) or 1 (position of the anterior vaginal wall more than 1 cm above the hymen), and the subjective absence of symptoms of vaginal bulging 12 months after the surgery.

The results showed that at one year, the primary outcome was significantly more common in the women treated with transvaginal mesh repair (60.8%) than in those who underwent colporrhaphy (34.5%). Conversely, surgery lasted longer and rates of intraoperative hemorrhage were higher in the mesh-repair group than in the colporrhaphy group. Rates of bladder perforation were 3.5% in the mesh-repair group and 0.5% in the colporrhaphy group, and the respective rates of new stress urinary incontinence after surgery were 12.3% and 6.3%, respectively; surgical reintervention to correct mesh exposure during follow-up occurred in 3.2% of 186 patients in the mesh-repair group. The study was published in the May 12, 2011, issue of New England Journal of Medicine (NEJM).

"The new surgical method has distinct advantages over traditional surgery," said lead author associate professor Christian Falconer, MD. "But the fact that the risk of complications increases means that we must be careful to inform the patient and weigh up the pros and cons of the two methods in every individual case."

Prolapse is a common post-childbirth condition and involves the loss of support for the vagina and pelvic organs, which descend and in some cases protrude through the vaginal opening. In recent years, it has been observed that traditional prolapse surgery often fails to produce the desired results. In Sweden an estimated 7-8,000 prolapse operations are performed annually, compared to approximately 300,000 procedures each year in the United States.

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