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Randomized Controlled Trial
. 2009 Sep;116(10):1380-6.
doi: 10.1111/j.1471-0528.2009.02254.x. Epub 2009 Jul 7.

Vaginal repair with mesh versus colporrhaphy for prolapse: a randomised controlled trial

M Carey  1 , P Higgs, J Goh, J Lim, A Leong, H Krause, A Cornish
Affiliations
Free PMC article
Randomized Controlled Trial

Vaginal repair with mesh versus colporrhaphy for prolapse: a randomised controlled trial

M Carey et al. BJOG. 2009 Sep.
Free PMC article

Abstract

Objective: To compare vaginal repair augmented by mesh with traditional colporrhaphy for the treatment of pelvic organ prolapse.

Design: Prospective randomised controlled trial.

Setting: Tertiary teaching hospital.

Population: One hundred and thirty-nine women with stage >or=2 prolapse according to the pelvic organ prolapse quantification (POP-Q) system requiring both anterior and posterior compartment repair.

Methods: Subjects were randomised to anterior and posterior vaginal repair with mesh augmentation (mesh group, n = 69) or traditional anterior and posterior colporrhaphy (no mesh group, n = 70).

Main outcome measures: The primary outcome was the absence of POP-Q stage >or=2 prolapse at 12 months. Secondary outcomes were symptoms, quality-of-life outcomes and satisfaction with surgery. Complications were also reported.

Results: For subjects attending the 12-month review, success in the mesh group was 81.0% (51 of 63 subjects) compared with 65.6% (40/61) in the no mesh group and was not significantly different (P-value = 0.07). A high level of satisfaction with surgery and improvements in symptoms and quality-of-life data were observed at 12 months compared to baseline in both groups, but there was no significant difference in these outcomes between the two groups. Vaginal mesh exposure occurred in four women in the mesh group (5.6%). De novo dyspareunia was reported by five of 30 (16.7%) sexually active women in the mesh group and five of 33 (15.2%) in the no mesh group at 12 months.

Conclusion: In this study, vaginal surgery augmented by mesh did not result in significantly less recurrent prolapse than traditional colporrhaphy 12 months following surgery.

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Figures

Figure 1
Figure 1
A cross-shaped mesh was used for the anterior vaginal repair. The extension arms were placed into each paravaginal space.
Figure 2
Figure 2
A ‘Y’-shaped mesh was used for the posterior vaginal repair. The extensions arms abutted each sacrospinous ligament.
Figure 3
Figure 3
Study flow chart.
See this image and copyright information in PMC

Comment in

References

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