Long-Term Outcomes of Transvaginal Mesh in Younger Women: A Retrospective Study.

Abstract

<h4>Introduction and hypothesis</h4>Despite FDA bans due to safety concerns, transvaginal mesh (TVM) offers lower recurrence rates for pelvic organ prolapse (POP) compared to native tissue repair. Current Chinese guidelines recommend TVM for recurrent or severe POP (POP-Q stage III-IV) in patients over 60 years. However, evidence regarding its long-term outcomes in younger patients (median age ≤ 60 years) remains limited.<h4>Methods</h4>This retrospective study included women who underwent TVM from 2013 to 2023 at a tertiary medical center. Baseline characteristics and perioperative details were extracted from electronic medical records. Follow-up data were collected through telephone interviews and/or in-person examination and questionnaires. Primary outcome was subjective surgical success. Secondary outcomes were quality of life changes and surgery-related adverse events, including mesh exposure, sexual dysfunction, and urinary complications.<h4>Results</h4>Of 728 women who underwent TVM, 140 (median age 56) were analyzed. At the last follow-up with a median of 52 months (IQR 12, 74), all 140 patients (100%) completed telephone questionnaires, while 42 (30.0%) additionally underwent in-person examination. The subjective cure rate was 95.7% (95% CI, 92.3-99.1%). Quality of life significantly improved postoperatively (both PFIQ-7 and PFDI-20 scores, P < 0.001). Only 4.3% (95% CI, 0.9-7.7%) had mesh exposure. Sexual activity and function remained stable, with a low rate of dyspareunia (4.3%).<h4>Conclusions</h4>TVM demonstrate satisfactory clinical results and a low complication rate in women ≤ 60 with severe POP. It does not significantly impair sexual function in patients who remain sexually active postoperatively.