Treatment of anterior vaginal wall prolapse with and without polypropylene mesh: a prospective, randomized and controlled trial - Part I

Abstract

Objective: To compare the use of polypropylene mesh (PM) and the traditional anterior vaginal wall colporraphy in women with anterior vaginal wall prolapse (AVWP) using objective and subjective tests and evaluation of quality of life (QoL). Materials and Methods: One hundred women were randomly distributed in two preoperatory groups. The first group (mesh) (n = 45) received a PM implant and the control group (n = 55) was submitted to traditional colporraphy. Postoperatory follow-up was done after 12 months. The primary objective was the correction of the Ba point ≤ -2 POP-Q (Pelvic Organ Prolapse Quantification System) and the secondary objective was the improvement of vaginal symptoms and QoL through ICIQ-VS (International Consultation on Incontinence Questionnaire -Vaginal Symptoms). Complications related to the use of PM or not were also described.Results: There was a significant difference between all POP-Q measures of pre-and postoperatory periods of each group in particular. There was a significant difference of the Ba point of the postoperatory period between the Mesh and Control group. The mean of Ba point in the Mesh group was statistically lower than of the Control group, depicting the better anatomical result of the first group. Both techniques improved vaginal symptoms and QoL. The most frequent complication of the Mesh group was prepubic hematoma in the perioperative period. In 9.3% of the cases treated with mesh it was observed PM exposition at the anterior vaginal wall after 12 months, being most of them treated clinically. Conclusion: The treatment of AVWP significantly improved the Ba point in the Mesh group in comparison to the Control group. There were no differences of the vaginal symptoms and QoL between the two groups after 12 months. There were few and low grade complications on both groups.

Anterior colporrhaphy: a standard operation? Systematic review of the technical aspects of a common procedure in randomized controlled trials

“…Forty RCTs remained after removal of duplicates and studies not matching the eligibility criteria (Table 1 ). The indications for AC were urinary incontinence [ 10 – 12 ], pelvic organ prolapse [ 13 , 15 , 16 , 19 – 23 , 25 – 27 , 29 – 38 , 40 , 41 , 43 – 49 ] or both [ 14 , 17 , 18 , 24 , 28 , 39 , 42 ].

Fig.

…”

Mesh Surgery for Anterior Vaginal Wall Prolapse: A Meta-analysis

“…This meta-analysis showed that the use of meshes for the treatment of anterior vaginal wall prolapse is superior to native tissue surgical repair, when objective cure through POP-Q assessment is considered. [14][15][16][17][18][19][20][21][22][23][24][25] All of the articles included in this meta-analysis considered as an objective cure criterion a post-surgical POP-Q stage inferior to 2 in the pelvic examination. This definition of cure, that is, when the prolapse's maximum extent stays at least 1 cm above the hymenal ring, is based on the recommendations of the US National Institute of Health (NIH) workshop.…”

A Prospective, Randomized, Controlled Trial of the Treatment of Anterior Vaginal Wall Prolapse: Medium Term Followup

“…Exclusion criteria, sample size calculation, blinding and randomization processes, 9 and the traditional anterior colporrhaphy surgical technique 3 were previously reported. 7 Women were randomly distributed to a PM group of 45 treated with a PM implant and a control group of 55 treated with anterior colporrhaphy without PM.…”