Should we abandon the use of transvaginal mesh in woman's pelvic floor reconstructive surgery? - 10 years of experience in the field of vaginal pelvic floor surgery.

Abstract

Objectives: The aim of the study was to investigate how surgical management strategies for pelvic organ prolapse (POP) have changed in a single-centre department over the last decade, as Food and Drug Administration (FDA) warnings have changed worldwide attitudes to mesh augmented reconstruction.

Material and methods: The study group consisted of 4180 patients who were operated on due to advanced symptomatic POP (≥ 2 POP-Q scale) from January 2010 to December 2020. Patients were divided into three groups depending on the type of POP vaginal surgery performed: group 1 - vaginal native tissue repair (VNTR) - (n = 1376); group 2 - transvaginal mesh repair (TVM; anterior, posterior, or both) - (n = 2494), and group 3 - transvaginal hysterectomy (TVH) - (n = 310). The clinical effectiveness of each type of procedure was estimated by means of the NIH Pelvic Floor Disorders Network criteria.

Results: The number of VNTR surgeries has significantly increased since 2017, following FDA warnings about the safety of these surgeries. The reoperation rate during the follow-up period did not differ between the investigated groups. However, urgency occurrence was significantly lower in the VNTR group when compared to the TVM and TVH groups (p < 0.05).

Conclusions: In most cases of symptomatic POP, vaginal native tissue repair is a safe and effective primary treatment. Based on the reoperation rate and the functional outcome we have not found any evidence of benefits from augmenting surgical prolapse repairs with polypropylene mesh inlays.