Mesh Support for Vaginal Prolapse Repair Is Prone to Erosion

Polypropylene mesh placement during vaginal reconstructive surgery for pelvic organ prolapse appears to do more harm than good, according to a new study.

Researchers at the Washington Hospital Center (WHC, Washington, DC, USA), Rush Medical College (Chicago, IL, USA), and other institutions conducted a double blind, multicenter randomized controlled trial comparing traditional vaginal prolapse surgery (without mesh) with vaginal surgery with mesh. A total of 65 women (mean age 65) with uterovaginal or vaginal prolapse were randomly assigned to either colpopexy with mesh (32 patients) or vaginal colpopexy without mesh (33 patients); women with a uterus also underwent vaginal hysterectomy. The primary outcome measure was objective treatment success at 3 months; secondary outcome measures included quality-of-life (QOL) variables and complication rates.

The results showed that there were no statistically significant baseline differences between the mesh and no-mesh groups with respect to demographics, menopausal status, and race. Analysis of the mesh and no-mesh women also found no difference with respect to overall recurrence. However, there were five (15.6%) vaginal mesh erosions during follow-up. Subjective cure of bulge symptoms was noted in 93.3% of mesh patients and 100% of no-mesh patients. The subjective QOL measurements did not differ between the two groups at baseline or three months postoperatively. The study was published in the August 2010 issue of Obstetrics and Gynecology.

"At 3 months, there is a high vaginal-mesh erosion rate with no difference in overall objective and subjective cure rates,” concluded lead author Cheryl Iglesia, M.D., of WHC, and colleagues. "This study questions the value of additive synthetic polypropylene mesh for prolapse repairs considering that there are no statistically significant differences in subjective or objective cure rates.”

About half of all women between the ages of 50 and 79 have some form of prolapse, and about 11% in the United States will have it surgically treated, with approximately 200,000 procedures for correction of pelvic organ prolapse performed each year in the United States alone.

Related Links:
Washington Hospital Center
Rush Medical College