Long-Term Observation on Postoperative Recurrence and Complications of Transvaginal Mesh Surgery for Pelvic Organ Prolapse

Abstract

Objective: This study aims to evaluate the risk factors for subjective recurrence and complications of patients who underwent transvaginal synthetic mesh surgery. Design：This retrospective cohort study included patients who received transvaginal mesh (TVM) surgery between January 2005 and June 2019. Methods: The information of patients was collected, including basic characteristics, subjective recurrence, and mesh-related complications. The clinical characteristics of patients with and without subjective recurrence were compared. The sexual activities of patients before and after the operation were recorded. SPSS 20.0 was used for the statistical analysis. Results: A total of 257 patients were included. Among them, 62 (24.1%) patients were lost to follow-up. The median follow-up time was 80 months (12 months, 170 months). Finally, 195 patients were followed up, 11 (5.6%) patients had a subjective recurrence of pelvic organ prolapse, and 26 (13.3%) patients had mesh-related complications (11 patients with de novo pain and 15 patients with mesh exposure). We found significant differences in age (68.9±5.1 vs. 63.4±5.8 years old), years of post-menopause (17.5±6.3 vs. 13.3±6.9 years), previous hysterectomy (27.3% vs. 6.0%), and concomitant hysterectomy (45.5% vs. 81.0%) between patients with and without subjective recurrence (P<0.05). The mesh exposure proportion of patients with total vaginal mesh (47.6%) was significantly higher than that with anterior vaginal mesh (2.9%) (P<0.05). Furthermore, 6.7% of sexually active patients reported do novo dyspareunia. Limitation: The investigators could only record the subjective recurrence of patients, thus there is a lack of objective recurrence data. Conclusion: Age, years of post-menopause and previous hysterectomy are risk factors for subjective recurrence of transvaginal mesh surgery; however，concomitant hysterectomy is a protective factor. Mesh exposure is the most common complication, especially for total vaginal mesh repair surgery.

Long-term safety and efficacy of non-absorbable abdominal mesh for apical prolapse surgery: A 10-year experience at Tertiary Care Hospital

“…This finding is in line with a study done in China where the subjective recurrence was 5%. 26 years respectively, while in our study patients were followed for one year. 17,27 Limitations: Despite the apparent strengths of the study, we did counter some limitations.…”

“…This finding is in line with a study done in China where the subjective recurrence was 5%. 26 Subsequently, a study by Unger et al reports a higher recurrence rate of 43%. 27 A reason for this higher recurrence in studies done by Unger et al and Pedersen KD et al is a longer follow-up period of six and seven years respectively, while in our study patients were followed for one year.…”

Minimally Invasive Vaginal Natural Orifice Transluminal Endoscopic Surgery Technique for Successful Polypropylene Mesh Removal in Pelvic Organ Prolapse: A Case Report

“…A notable concern in surgeries involving mesh and hysterectomy for POP treatment, such as in our patient, is the potential for spontaneous recurrence after TVM surgery. This complexity is compounded by the risk of foreign body reactions and inflammation around the mesh and adjacent tissues, which are common pathological findings in such cases [17]. Although direct studies on vNOTES in this context are limited, the minimally invasive nature of the procedure suggests the possibility of reduced tissue trauma and inflammatory response, which are critical factors for postoperative recovery and long-term tissue integration.…”