The use of transvaginal synthetic mesh for anterior vaginal wall prolapse repair: a randomized controlled trial

• DOI: 10.1007/s00192-013-2092-0
• Publication Date: 2013-04-30T18:30:02Z
• Authors: Carlos A. Delroy; Rodrigo de A. Castro; Márcia M. Dias; Paulo C. Feldner; Maria Augusta T. ...; Manoel J. B. C. G...; Marair G. F. Sartori
• Keywords: Urology; Middle Aged; Surgical Mesh; Pelvic Organ Prolapse; 3. Good health; 03 medical and health sciences; Gynecologic Surgical Procedures; Postoperative Complications; Treatment Outcome; 0302 clinical medicine; Obstetrics and Gynaecology; Humans; Original Article; Female; Brazil; Aged

The aim of the study was to compare the efficacy and safety of transvaginal trocar-guided polypropylene mesh insertion with traditional colporrhaphy for treatment of anterior vaginal wall prolapse.This is a randomized controlled trial in which women with advanced anterior vaginal wall prolapse, at least stage II with Ba ≥ +1 cm according to the Pelvic Organ Prolapse Quantification (POP-Q) classification, were randomly assigned to have either anterior colporrhaphy (n = 39) or repair using trocar-guided transvaginal mesh (n = 40). The primary outcome was objective cure rate of the anterior compartment (point Ba) assessed at the 12-month follow-up visit, with stages 0 and I defined as anatomical success. Secondary outcomes included quantification of other vaginal compartments (POP-Q points), comparison of quality of life by the prolapse quality of life (P-QOL) questionnaire, and complication rate between the groups after 1 year. Study power was fixed as 80% with 5% cutoff point (p < 0.05) for statistical significance.The groups were similar regarding demographic and clinical preoperative parameters. Anatomical success rates for colporrhaphy and repair with mesh placement groups were 56.4 vs 82.5% (95% confidence interval 0.068-0.54), respectively, and the difference between the groups was statistically significant (p = 0.018). Similar total complication rates were observed in both groups, with tape exposure observed in 5% of the patients. There was a significant improvement in all P-QOL domains as a result of both procedures (p < 0.001), but they were not distinct between groups (p > 0.05).Trocar-guided transvaginal synthetic mesh for advanced anterior POP repair is associated with a higher anatomical success rate for the anterior compartment compared with traditional colporrhaphy. Quality of life equally improved after both techniques. However, the trial failed to detect differences in P-QOL scores and complication rates between the groups.