Vaginal mesh surgery had a significantly lower failure rate than did sacrospinous vaginal colpopexy in women with vaginal vault prolapse and levator ani avulsion, investigators reported online March 11 in Ultrasound in Obstetrics & Gynecology.
At 1-year follow-up, 3% of patients treated with mesh had anatomic failure based on clinical and ultrasound evaluation, compared with 62%-65% of patients who underwent unilateral vaginal sacrospinous colpopexy with native tissue vaginal repair, reported Dr. Kamil Svabik and his associates at General University Hospital and the Charles University in Prague.
Vaginal mesh has been linked to adverse effects, so the researchers enrolled patients with post hysterectomy vaginal vault prolapse who also had levator ani avulsion only. "We considered it potentially unethical to offer mesh to all patients with post hysterectomy prolapse due to concerns about mesh complications, and since there is some evidence that reduction in recurrence due to mesh may be limited largely to patients with levator avulsion," they said (Ultrasound Obstet. Gynecol. 2014 March 11 [doi:10.1002/uog.13305]).
Among 70 women with ultrasound-diagnosed avulsions, 36 were randomized to the vaginal mesh procedure and 34 underwent sacrospinous fixation. At 1-year follow-up, there was one anatomic failure in the mesh group, while 22 (65%) patients in the sacrospinous fixation group had prolapses to the hymen or beyond, and 21 (63%) met ultrasound criteria for prolapse. The groups did not differ significantly in terms of incontinence, sexual function, or prolapse symptoms, which the researchers said might be because of the lack of power. No serious adverse effects were reported for either group.
The Gynecare Prolift mesh used in the study has been taken off the market, the investigators said, adding that other type-I polypropylene meshes might achieve similar results. They planned to assess long-term outcomes and complications.
The study was supported by the Grant Agency of the Ministry of Health of the Czech Republic and by Charles University in Prague. The authors disclosed no conflicts of interest except Dr. Martan, who reported having consulted for Bard, Gynecare, and AMS.