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Randomized Controlled Trial
. 2013 Oct;122(4):770-777.
doi: 10.1097/AOG.0b013e3182a49dac.

Three-year outcomes of vaginal mesh for prolapse: a randomized controlled trial

Robert E Gutman  1 , Patrick A Nosti, Andrew I Sokol, Eric R Sokol, Joanna L Peterson, Hong Wang, Cheryl B Iglesia
Affiliations
Randomized Controlled Trial

Three-year outcomes of vaginal mesh for prolapse: a randomized controlled trial

Robert E Gutman et al. Obstet Gynecol. 2013 Oct.

Abstract

Objective: To present the 3-year outcomes of a double-blind, multicenter, randomized trial comparing vaginal prolapse repair with and without mesh.

Methods: This was a planned final analysis of women with Pelvic Organ Prolapse Quantification (POP-Q) stage 2-4 prolapse randomized to traditional vaginal prolapse surgery without mesh and vaginal colpopexy repair with mesh. We evaluated anatomic, symptomatic, and combined cure rates for those with at least 3-year validated quality-of-life questionnaires and 2- or 3-year postoperative blinded POP-Q examination. Participants undergoing reoperation for recurrent prolapse were removed for anatomic and subjective outcomes analysis and considered failures for combined outcomes analysis.

Results: Sixty-five women were enrolled (33 mesh, 32 no mesh) before the study was prematurely halted as a result of a 15.6% mesh exposure rate. At 3 years, 51 of 65 (78%) had quality-of-life questionnaires (25 mesh, 26 no mesh) and 41 (63%) had examinations. Three participants died, three required reoperation for recurrent prolapse (all in mesh group), and eight were lost to follow-up. No differences were observed between groups at 3 years for prolapse stage or individual prolapse points. Stage improved for each group (90% and 86%) from baseline to 3 years (P<.01). Symptomatic improvement was observed with no differences in scores between groups. Cure rates did not differ between groups using a variety of definitions, and anatomic cure was lowest for the anterior compartment.

Conclusion: There was no difference in 3-year cure rates when comparing patients undergoing traditional vaginal prolapse surgery without mesh with those undergoing vaginal colpopexy repair with mesh.

Clinical trial registration: Clinicaltrials.gov, www.clinicaltrials.gov, NCT00475540.

Level of evidence: : I.

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References

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