Are transvaginal mesh procedures a good long-term treatment for pelvic organ prolapse?

This study evaluated the long-term effects and safety of transvaginal mesh procedures. Researchers concluded that transvaginal mesh procedures are associated with moderate long-term physical repair of pelvic organ prolapse. 

Transvaginal mesh procedures involve the implantation of a net-like structure through the vagina, and are commonly used to treat pelvic organ prolapse and stress urinary incontinence in women. Compared to open surgery, this method is associated with shorter operating times and faster recovery. However, transvaginal mesh procedures have previously been associated with higher complication rates. Despite the widespread use of transvaginal mesh procedures, their long-term effects and safety are still under exam.

This study included 161 women undergoing transvaginal mesh procedures for pelvic organ prolapse. Treatment satisfaction and outcomes were analyzed an average of 7 years after surgery.

Overall, 80% of women reported that they were satisfied with the procedure. Pelvic floor symptoms, urinary or anal incontinence, and constipation all received low scores, indicating minor pelvic organ prolapse symptoms at follow-up. Physical examinations of pelvic organs revealed that while 69% of women showed no prolapse (dropping) of the vaginal wall, only 56% of women showed no or minimal prolapse of larger pelvic organs.

Exposure of the implanted mesh through the vaginal skin was detected in 23% of women. Mesh exposure was rarely associated with symptoms (only in 33% of cases) and generally occurred several months after the procedure. 16% of women required a second pelvic organ repair surgery due to recurrent symptoms. Painful sexual intercourse was reported in 13% of sexually active women.

The researchers concluded that transvaginal mesh procedures are associated with a satisfactory long-term treatment outcome. Women should be informed about possible complications before surgery.

Larger clinical trials are needed to examine the long-term effects and safety of transvaginal mesh procedures.