Effectiveness and complications in transvaginal placement of mesh, for pelvic
organ prolapse in women, our experience.
Vikiela Galica , Elona Toska, Pietro Saldutto, Stefano Masciovecchio, Alessandro del Rosso, Ezio Domenico Di Pierro,
Giuseppe Paradiso Galatioto, Carlo Vicentini. University of L’Aquila, Urology Departament of “G. Mazzini” Hospital,
Teramo.
INTRODUCTION & OBJECTIVES: The aim of this study was to evaluate the effectiveness and safety of the transvaginal
placement of surgical mesh, in repair of pelvic organ prolapse (POP).
MATERIAL & METHODS: 180 women with POP underwent transvaginal surgical management in our clinic from april
2004 till november 2011with mesh placement. Of the initial 180 women 130 women with not less than 2 years of followup after surgery were included. Physical examination, 1 hour pad-test, POP-Q score for assessing the degree of
prolapse and urodinamic evaluation were performed before surgery. All patients were followed-up with a straight physical
examination for 1, 3, 6 and 12 months post-operatively and then annually. The patients were divided into 2 groups. In the
first group (group 1) were included patients with a median time of 2 years of follow-up. On the other hand we selected
patients with a median time of 5 years of follow-up (group2). Complications such as recurrance in pelvic organ prolapse,
SUI, mesh-erosion, overactive bladder (OAB), dispareunia, organ perforation and dyschezia were evaluated.
Discussion: The non-absorbable material of the mesh is thought to stay intact over time, but there are changes in the
aging tissues where the mesh is implanted and there has been fear for late-onset erosion problems.
RESULTS: The age distribution in both groups are depicted in table 1. Table 2 shows other pelvic surgeries performed
before, during and after transvaginal placement of the mesh. We evaluate the degree of prolapse after 7 years of
experience and we found a complete reconstruction of the pelvic floor in 82 % of the patients. Only 8 patients underwent
a new SUI surgery in a second time. Table 3 shows the number and the nature of acquired medical conditions and
initiated medications since last follow-up visit in both groups. Watchful waiting approach seemed us to be the best choice
in the recurrence of prolapse estabilished as a I-II degree in asymptomatic patients. Nevertheless mesh contraction
causing vaginal pain is increasingly reported in the literature only 14 women on both groups referred dyspareunia. A low
rate of dyschezia was found which improved positively using laxative products. New overactive bladder (OAB)
symptoms were found in both groups. The management with anticholinergic drugs of OAB resulted successfully in most
of them. We found only 4 cases of mesh erosion in both groups and it is reassuring that we didn’t find a single case of
organ perforation. The rate of dyspareunia and OAB were higher in the second group. The other complications were
almost the same in both groups.
CONCLUSIONS: We feel that the results of this follow-up study are reassuring on the safety and effectiveness of the
mesh use in POP surgery. This results should be able to achieve at any clinic where surgeons are offered systematic
training and proper patients selection is undertaken.
Age
<60
61-70
130 patients
Group 1 (31 pt)
2
15
Group 2 (99 pt)
5
41
71-80
81-90
Type of surgery
12
1
Table 1.
Group 1
Previous
9
Hysterectomy
Concomitant
4
Secondly
2
Perioneoplasty
Concomitant
14
SUI surgery
Secondly
2
New surgery for
2
Recurrent prolapse
prolapse
Waiting
4
Table 2. Type of surgery improved in both groups of patients.
47
6
Group 2
38
28
2
28
6
6
19
130 patients
Group 1 No pt (%)
Group 2 No pt (%)
Treatment
SUI
5 (5%)
1 (3%)
Waiting
OAB
12 (!2%)
2 (6%)
anticholinergic
Prolapse actually
19 (19%)
4 (12%)
Watchful waiting
Dyschezia
4 (4%)
1 (3%)
Laxative therapy
Dyspareunia
12 (12%)
2 (6%)
Pelvic rehabilitation
Erosion
3 (3%)
1 (3%)
Estrogen local therapy
Organ perforation
0
0
Table 3. Follow-up data after last visit and medical treatment improved.