Pelvic Floor Reconstruction Using Mesh Versus Campbell Uterosacral Ligament Suspension: 2-Year Clinical Outcome.

Abstract

Introduction and hypothesis: The present study is aimed at comparing the clinical outcome and patient satisfaction between transvaginal modified pelvic floor reconstruction using the titanized polypropylene lightweight mesh (MPFR-mesh) and transvaginal Campbell uterosacral ligaments suspension (C-USLS) in women with apical and anterior prolapse.

Methods: We performed a single-center retrospective cohort study including women who underwent a vaginal hysterectomy with concomitant MPFR-mesh or C-USLS from January 2018 and December 2020 with a 2-year follow-up. The primary outcome was composite surgical successful rate (retreatment of prolapse, Ba or Bp beyond 1 cm above the hymen, the C point above total vaginal length/2, or prolapse symptoms), and the secondary outcome included Pelvic Organ Prolapse Quantification (POP-Q) data (Ba、Bp、C, and TVL), adverse events, and patient satisfaction.

Results: A total of 175 patients were determined according to our study's inclusion criteria: 78 patients underwent MPFR-mesh, whereas 97 patients had C-USLS. With regard to cystocele, in the MPFR-mesh group, 68 (87.2%) had stage III, 10 (12.8%) had stage IV, and in the C-USLS group, 76 (78.4%) had stage III, 1 (1.0%) had stage IV; a significant difference was noted (p < 0.05). No differences were observed among women who underwent MPFR-mesh vs C-USLS with regard to the composite surgical success rate (88.5% vs 85.6%; p = 0.573). Consistent with multivariate analysis, after controlling for age, preoperative points Ba and C, body mass index, vaginal deliveries, posterior colporrhaphy, and perineorrhaphy, there was no discernable difference in recurrence rates between the two procedures. In addition, it was interesting to find that there was a difference in TVL and point C between the two groups after surgery (p < 0.05), but that there was no statistically significant difference in the Ba and Bp points (p > 0.05). Patient satisfaction was equally high in the MPFR-mesh group as in the C-USLS group (94.9% vs 96.9%; p = 0.768). Adverse events in the MPFR-mesh group vs the C-USLS group included mesh exposure (3.8% vs 0%), and ureteral kinking (0% vs 2.1%).

Conclusions: Modified pelvic floor reconstruction with mesh and C-USLS both have high composite surgical successful rates and patient satisfaction throughout 2 years. The C-USLS group may have longer vaginal length than the MPFR-mesh group after surgery. For patients with POP-Q stage III anterior prolapse and concurrent apical prolapse who are worried about potential mesh complications, this C-USLS could be an alternative.