Functional and anatomical outcome of anterior and posterior vaginal prolapse repair with prolene mesh

Authors


Dr S. Salvatore, Via Ciro Menotti 76, 2100 Varese, Italy.

Abstract

Objective  To evaluate the effects of prolene mesh on urinary, bowel and sexual function in prolapse surgery.

Design  Prospective observational study on consecutive women.

Setting  Two referral uorgynaecological units in Italy.

Population  Women requiring prolapse repair for anterior or posterior vaginal prolapse.

Methods  All women were assessed for urinary, bowel, prolapse symptoms and dyspareunia pre- and post-operatively. Urodynamics was performed in selected cases. Surgery consisted of an anterior or posterior repair plus a prolene mesh. Follow up was after 1, 6 and 12 months. The ANOVA test was used for statistical analysis.

Main outcome measures  Vaginal anatomical restoration, urinary, bowel and sexual function.

Results  We recruited 63 women (mean age 63 years) with a mean follow up of 17 months. Anatomically, the success rate was 94%. Thirty-two women had an anterior repair. Among this group, the sexual activity rate did not alter but dyspareunia increased by 20%. Urge and stress incontinence did not change post-operatively but urgency improved in 10% and 13% had vaginal erosion of the mesh. Thirty-one women had a posterior repair. Among this group, sexual activity decreased by 12% and dyspareunia increased in 63%. Constipation improved in 15% and anal incontinence in 4%, and 6.5% of women had vaginal erosion of the mesh and one required mesh removal for pelvic abscess.

Conclusions  Although this study shows good anatomical results with the use of prolene mesh for prolapse repair, there was a high rate of morbidity. We believe that the use of prolene mesh should be abandoned.

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