No mesh versus mesh in the treatment of anterior vaginal wall prolapse: prospective, randomised, controlled trial, long-term follow-up

Abstract

Objectives: To compare the efficacy and safety of anterior colporrhaphy (AC) versus transvaginal polypropylene mesh (PM) for the treatment of anterior vaginal wall prolapse (AVWP) at long-term follow-up.

Methods: Prospective and randomized controlled trial, 100 women with AVWP stage ≥ II assessed by the Pelvic Organ Prolapse Quantification System (POP-Q) underwent AC (control group) or PM insertion (mesh group). At baseline and at 60-month follow-up, safety profile, anatomical outcomes by POP-Q measurements and staging, subjective outcomes and quality of life (QoL) impact by ICIQ (SF and VV) and OAB-V8 questionnaires were assessed RESULTS: 76 women completed the study, 43 in Control versus 33 in Mesh group. Significant improvements were observed in all variables between the 2 times in each group (p < 0.0001), without differences between groups. Objective cure (POP-Q Ba ≤ - 2 and Ba ≤ - 1) occurred in 22 and 36 (51.2 and 83.7%) versus 23 and 31 (69.7 and 93.9%), p = 0.10 and 0.29; and subjective cure (VSS, no vaginal symptom) in 21 (48.8%) versus 17 (51.5%), p = 0.82, respectively, at 60-month follow-up. When adjusted for the other variables, Mesh group showed worse QoL impact due to subjective vaginal symptoms (odds ratio 3.99, CI 95% 1.13; 14.13). AVW asymptomatic mesh exposure occurred in 2 patients (6.06%) in the Mesh group.

Conclusions: AC and PM provided good overall objective and subjective outcomes for a minimum 60-month follow-up. Vaginal and urinary symptoms improved post-operatively in both groups. Mesh group experienced four times more negative impact on QoL compared to Control at 60-month follow-up.

Keywords: Long-term outcome; Pelvic organ prolapse; Polypropylene; Quality of life; Surgical mesh.