Transvaginal Mesh May Be Best for Pelvic Organ Prolapse

But tied to higher risk of complications and adverse events compared with colporrhaphy

WEDNESDAY, May 11 (HealthDay News) -- Use of mesh to repair anterior vaginal wall prolapse appears to result in better outcomes than traditional colporrhaphy at one year, but mesh is associated with more complications and postoperative adverse events, according to research published in the May 12 issue of the New England Journal of Medicine.

Daniel Altman, M.D., Ph.D., of the Karolinska Institute in Stockholm, Sweden, and colleagues randomly assigned 389 women with prolapse of the anterior vaginal wall to repair with a transvaginal polypropylene-mesh kit or traditional colporrhaphy to see if the former resulted in better outcomes than the latter.

The researchers found that, in the mesh kit repair group, 60.8 percent obtained 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 post-surgery, compared with 34.5 percent who underwent colporrhaphy. Surgery duration and intraoperative hemorrhage were greater in the mesh group (P < 0.001 for both comparisons), which also experienced higher rates of bladder perforation (3.5 versus 0.5 percent; P = 0.07) and new stress urinary incontinence post-surgery (12.3 versus 6.3 percent; P = 0.05).

"When one is counseling patients regarding surgical options, the benefits of the mesh kit must be balanced against the higher rates of surgical complications and postoperative adverse events associated with this approach," the authors conclude.

The research was supported in part by Ethicon; several authors disclosed financial relationships with Ethicon, Contura A/S, and Gynecare Scandinavia.

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