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Randomized Controlled Trial
. 2018 Jun;29(6):847-858.
doi: 10.1007/s00192-017-3512-3. Epub 2017 Nov 22.

Long-term outcome of vaginal mesh or native tissue in recurrent prolapse: a randomized controlled trial

Alfredo L Milani  1 , Anne Damoiseaux  2 , Joanna IntHout  3 , Kirsten B Kluivers  4 , Mariella I J Withagen  5
Affiliations
Randomized Controlled Trial

Long-term outcome of vaginal mesh or native tissue in recurrent prolapse: a randomized controlled trial

Alfredo L Milani et al. Int Urogynecol J. 2018 Jun.

Abstract

Introduction and hypothesis: Our aim was to evaluate clinically relevant long-term outcomes of transvaginal mesh or native tissue repair in women with recurrent pelvic organ prolapse (POP).

Methods: We performed a 7-year follow-up of a randomized controlled trial on trocar-guided mesh placement or native tissue repair in women with recurrent POP. Primary outcome was composite success, defined as absence of POP beyond the hymen, absence of bulge symptoms, and absence of retreatment for POP. Secondary outcomes were adverse events, pain, and dyspareunia. Multiple imputation was used for missing data of composite success and pain; estimates are presented with 95% confidence intervals (CI).

Results: Between August 2006 and July 2008, 194 women were randomized; 190 underwent surgery. At 7 years, 142 (75%) were available for analysis, of whom, the primary outcome could be calculated in 127. Composite success was 53% (95% CI 41, 66) for mesh and 54% (95% CI 42, 65) for native tissue. Repeat surgery for POP was 25% for mesh and 16% for native tissue (difference 9%; 95% CI -5, 23) and occurred in untreated compartments in the mesh group and treated compartments in the native tissue group. Mesh exposure rate was 42%; pain with mesh 39% and native tissue 50% (difference - 11%, 95% CI -27, 6); dyspareunia with mesh 20% and native tissue 17% (difference 3%, 95% CI -9, 17).

Conclusions: Seven-year composite success rates appeared similar for mesh and native tissue. Mesh did not reduce long-term repeat surgery rates due to de novo POP in nonmesh-treated vaginal compartments. Mesh exposure rates were high, though significant differences in pain and dyspareunia were not detected.

Clinical trial registration: ClinicalTrials.gov , NCT00372190.

Keywords: Long-term outcome; Mesh; Native tissue; Pain; Pelvic organ prolapse; Surgery.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Consolidated Standards of Reporting Trials (CONSORT) flowchart of randomization and follow-up. *Includes those lost to follow-up at 1 year
See this image and copyright information in PMC

References

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