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Postoperative voiding difficulty and mesh-related complications after Total Prolift System surgical repair for pelvic organ prolapse and predisposing factors

Zhang, Lei MD1; Zhu, Lan MD1; Xu, Tao PhD2; Liang, Shuo MD1; Lang, Jinghe MD1

doi: 10.1097/GME.0000000000000402
Original Articles

Objective We aimed to evaluate the incidence and predisposing factors of postoperative voiding difficulty and mesh-related complications.

Methods In this prospective cohort study, 206 consecutive women with advanced pelvic organ prolapse underwent surgical repair with the Prolift mesh kit at Peking Union Medical College Hospital, with a mean follow-up of 4.2 years. Postoperative voiding difficulty was defined as postvoid bladder volume of 100 mL or more (or more than one third of voided volume). The International Urogynecological Association/International Continence Society joint terminology was used for mesh-related complications and pain. Symptomatic recurrence was defined as symptomatic Pelvic Organ Prolapse Quantification stage II or higher. χ2 test and univariate or multivariate logistic regression were used for data analysis.

Results Fourteen (6.8%) women were lost to follow-up. Postoperative voiding difficulty occurred in 60 of 192 (31.25%) women; low preoperative average urine flow (odds ratio [OR], 4.7; 95% CI, 1.3-17.2) and residual urine volume (OR, 2.6; 95% CI, 1.3-5.0) were independent risk factors. In total, 85% (51 of 60) reported symptom resolution within 3 days. Women with a postoperative residual urine volume of 200 mL or more experienced a more difficult recovery (P = 0.01). Mesh-related complications were reported in 29 of 192 (15.1%) women, with vaginal complications (mesh exposure/contraction) accounting for 69.0% (20 of 29). Greater blood loss (OR, 5.9; 95% CI, 2.1-18.7) and past pelvic surgical operation (OR, 6.3; 95% CI, 1.3-23.8) were strongly related to these complications. Three hematomas (7A) and six skin complications (6B) were also reported. However, the small participant sample prevented pain and recurrence analyses.

Conclusions Low average urine flow rate and preoperative urinary retention can be used to predict postoperative voiding difficulty. Vaginal complications (mesh exposure/contraction) are the primary mesh-related complications and are predicted by greater blood loss and past pelvic surgical operation.

From the 1Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and 2Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing, China.

Received September 1, 2014; revised and accepted October 28, 2014.

L.Z. is an MD candidate training at Peking Union Medical College Hospital.

Clinical trial registration: ChiCTR-OCH-14004687 (Clinical;

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Lan Zhu, MD, No. 1 ShuaiFu Road, Dongcheng District, Beijing, China. E-mail:

© 2015 by The North American Menopause Society.