Transvaginal repair of anterior and posterior compartment prolapse with Atrium polypropylene mesh

Abstract

Objective: To determine the efficacy and safety of a new technique using Atrium polypropylene mesh (Atrium, Hudson, New Hampshire, USA) as an overlay graft for repair of large or recurrent anterior and posterior compartment prolapse.

Design: A retrospective review of women who had vaginal prolapse surgery with Atrium mesh reinforcement.

Setting: Tertiary referral urogynaecology unit in Australia.

Population: Forty-seven women where mesh was placed under the bladder base with lateral extensions onto the pelvic sidewall, 33 women where a Y-shaped mesh was placed from the sacrospinous ligaments to the perineal body and 17 women who had mesh placement in both compartments.

Methods: Women were assessed by site-specific vaginal examination pre-operatively and post-operatively at six weeks, six months and two years.

Main outcome measures: All complications. Rate of recurrent prolapse assessed by the Baden-Walker halfway classification system.

Results: Mean follow up was 29 months (range 6 to 52). Four of 64 women with anterior mesh placement (6%) developed a grade 2 asymptomatic cystocele. Five women (5%) required further surgery for recurrent prolapse at a non-mesh site. Erosion occurred in nine women (9%). Three healed after intravaginal oestrogen cream, five after excision of exposed mesh and vaginal closure and one woman also had surgical closure of a rectovaginal fistula. The risk of mesh erosion decreased over the study period. Urinary, coital and bowel symptoms were significantly improved following surgery.

Conclusions: This technique shows promise in correcting pelvic organ prolapse. Vaginal mesh erosion is the most common complication and is related to surgical experience.