Skip Navigation LinksHome > October 2013 - Volume 122 - Issue 4 > Three-Year Outcomes of Vaginal Mesh for Prolapse: A Randomiz...
Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e3182a49dac
Original Research

Three-Year Outcomes of Vaginal Mesh for Prolapse: A Randomized Controlled Trial

Gutman, Robert E. MD; Nosti, Patrick A. MD; Sokol, Andrew I. MD; Sokol, Eric R. MD; Peterson, Joanna L. RN; Wang, Hong PMD, MS; Iglesia, Cheryl B. MD

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Abstract

OBJECTIVE: To present the 3-year outcomes of a double-blind, multicenter, randomized trial comparing vaginal prolapse repair with and without mesh.

METHODS: This was a planned final analysis of women with Pelvic Organ Prolapse Quantification (POP-Q) stage 2–4 prolapse randomized to traditional vaginal prolapse surgery without mesh and vaginal colpopexy repair with mesh. We evaluated anatomic, symptomatic, and combined cure rates for those with at least 3-year validated quality-of-life questionnaires and 2- or 3-year postoperative blinded POP-Q examination. Participants undergoing reoperation for recurrent prolapse were removed for anatomic and subjective outcomes analysis and considered failures for combined outcomes analysis.

RESULTS: Sixty-five women were enrolled (33 mesh, 32 no mesh) before the study was prematurely halted as a result of a 15.6% mesh exposure rate. At 3 years, 51 of 65 (78%) had quality-of-life questionnaires (25 mesh, 26 no mesh) and 41 (63%) had examinations. Three participants died, three required reoperation for recurrent prolapse (all in mesh group), and eight were lost to follow-up. No differences were observed between groups at 3 years for prolapse stage or individual prolapse points. Stage improved for each group (90% and 86%) from baseline to 3 years (P<.01). Symptomatic improvement was observed with no differences in scores between groups. Cure rates did not differ between groups using a variety of definitions, and anatomic cure was lowest for the anterior compartment.

CONCLUSION: There was no difference in 3-year cure rates when comparing patients undergoing traditional vaginal prolapse surgery without mesh with those undergoing vaginal colpopexy repair with mesh.

CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, www.clinicaltrials.gov, NCT00475540.

LEVEL OF EVIDENCE: I

© 2013 by The American College of Obstetricians and Gynecologists.

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