Postoperative indications for further surgery following post-transvaginal Prolift^TM mesh repair after a two-year follow-up period: a single-centre study.

Abstract

We investigated the frequency of further surgery post-artificial mesh (Prolift^TM) repair of pelvic organ prolapse. In total, 257 patients who underwent Prolift^TM repair were evaluated for further surgery frequency, clinical outcomes, and demographic characteristics. Thirty-eight (14.7%) patients underwent further surgery (median time to reoperation, 9.5 months; range, 6-22 months). Six (2.3%) patients underwent prolapse repair at a different (5 patients, 1.9%) or same site (1 patient, 0.3%). One underwent posterior Prolift^TM repair; four, laparoscopic sacrocolpopexy; and one, vaginal hysterectomy. Eight (3.1%) underwent surgery for complications; seven (2.7%) required further surgery for mesh exposure (median, 8 months) and one (0.3%) required further surgery for mesh infection (1 month). Twenty-four (9.3%) received further surgery for stress urinary incontinence (median, 8.5 months). Despite the low frequency of further surgery post-Prolift^TM repair, mesh-related complications should be considered. Careful long-term follow-up is necessary.Impact Statement<b>What is already known on this subject?</b> It is widely known that vaginal mesh is used as treatment for pelvic organ prolapse (POP). Vaginal mesh is one of the treatment options for POP. However, it received a bad reputation following reports of complications associated with its use, leading to discontinuation of vaginal mesh in many countries.<b>What the results of this study revealed</b><b>?</b> The findings of this study show that few patients who received Prolift^TM repair required further surgery. The surgeries included surgery for non-POP-related conditions; subsequent surgery for stress urinary incontinence (SUI); surgery for complications including mesh exposure and infection; primary prolapse surgery for a different site and repeat surgery; and a repeat operation for prolapse arising from the same site.<b>What are the implications of these findings in clinical practice and/or further research?</b> Based on the outcome of this study, transvaginal Prolift^TM mesh repair is a reasonably safe and effective treatment for POP. Despite withdrawal of all mesh products from the market as instructed by the FDA, this study suggested the need to re-evaluate the role of vaginal mesh as a treatment option for POP.