Original Research

Trocar-Guided Transvaginal Mesh Repair of Pelvic Organ Prolapse

Elmér, Caroline MD^1,2; Altman, Daniel MD, PhD^2,3; Engh, Marie Ellström MD, PhD⁴; Axelsen, Susanne MD, PhD⁵; Väyrynen, Tapio MD⁶; Falconer, Christian MD, PhD² for the Nordic Transvaginal Mesh Group

Author Information

From the ¹Division of Surgery and Urology and ²Division of Obstetrics and Gynecology, Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden; ³Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; ⁴Department of Obstetrics and Gynaecology, Akershus University Hospital, University of Oslo, Lørenskog, Norway; ⁵Department of Obstetrics and Gynecology, Aarhus University Hospital, Skejby, Denmark; and ⁶Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Jorvi Hospital, Espoo, Finland.

See related article on page 127.

*For the other members of the Nordic Transvaginal Mesh Group who participated in this study, see the Appendix online at https://links.lww.com/A618.

Funded by university-administered research funds, including grants from the Swedish Society of Medicine and the regional agreement on medical training and clinical research (ALF) between Stockholm county council and Karolinska Institutet. Investigator meetings in relation to the study have been sponsored by Gynecare Scandinavia.

Corresponding author: Caroline Elmér, MD, Department of Surgery and Urology, Danderyd University Hospital, 182 88 Danderyd, Sweden; e-mail: [email protected].

Financial Disclosure Drs. Altman and Falconer have advisory positions for Gynecare Scandinavia (Stockholm, Sweden). The other authors did not report any potential conflicts of interest.

Obstetrics & Gynecology 113(1):p 117-126, January 2009. | DOI: 10.1097/AOG.0b013e3181922164

OBJECTIVE:

To prospectively assess clinical outcomes after pelvic organ prolapse repair with a standardized trocar-guided surgical device using polypropylene mesh.

METHODS:

This was a prospective multicenter cohort study performed throughout 26 clinics. Evaluation at baseline, 2 months, and 1 year after surgery included prolapse grading using the pelvic organ prolapse quantification system (POP-Q) and symptom assessment using the Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6). For the purpose of this study, postoperative POP-Q stage 0–I was considered anatomic cure.

RESULTS:

Two-hundred sixty-one patients were included in the study; 232 (89%) attended the 1-year follow-up. Mean±standard deviation age at surgery was 66.3±9.4 years. Anatomic cure 1 year after surgery was observed in 96 of 121 women (79%) after anterior repair with mesh (P<.001), and 56 of 68 (82%) after posterior repair with mesh (P<.001). For combined anterior and posterior mesh repair, cure was 51 of 63 (81%) and 54 of 63 (86%) for the anterior and posterior compartment, respectively (P<.001 for both). Bladder and rectal perforations occurred in 9 of 252 patients (3.4%). Vaginal erosions, the majority mild to moderate, occurred in 26 of 232 cases (11%). Surgical intervention due to mesh exposure occurred in seven cases (2.8%). There were significant quality-of-life improvements in all domains of the IIQ-7. Despite significant improvements in UDI-6 scores, symptoms specific for stress urinary incontinence were not ameliorated.

CONCLUSION:

Trocar-guided transvaginal mesh surgery for pelvic organ prolapse is associated with satisfactory objective and subjective outcomes 1 year after surgery.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, www.clinicaltrials.gov, NCT00402844

LEVEL OF EVIDENCE:

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