Vaginal mesh for prolapse: a long-term prospective study of 218 mesh kits from a single centre.

ABSTRACT

INTRODUCTION AND HYPOTHESIS: The aim was to assess the long-term surgical outcomes and complications in patients undergoing mesh-augmented vaginal repair of pelvic organ prolapse. METHODS: This is a report of a prospective long-term follow-up experience from the Urogynaecological Service, Counties Manukau District Health Board (CMDHB), Auckland, New Zealand. The subjects were 158 symptomatic women undergoing mesh-augmented prolapse repair (218 kits, Feb 2005 to July 2013) using the Apogee and/or Perigee kits (with IntePro mesh until November 2009, and IntePro Lite mesh thereafter). A dedicated electronic database was used. RESULTS: The median follow-up times were 138 and 105 weeks for the Apogee and Perigee kits, respectively; 56.6% and 48.8% of these kits, respectively, were inserted for recurrent prolapse. Cure rates for prolapse using mesh kits in patients with a history of native tissue POP repair in the same compartment were 90.91% for the anterior compartment (60 of 66) and 95.74% for the posterior compartment (45 of 47). The cumulative mesh extrusion/exposure rate was 15.8% of patients (11.5% of mesh kits) and was significantly higher with the Apogee kit than with the Perigee kit (P = 0.03). The rate of extrusion/exposure was significantly lower with IntePro Lite than with IntePro (P = 0.04 for Perigee and P = 0.0001 for Apogee). There was a significantly higher rate of extrusion/exposure with the Perigee kit in women with previous anterior compartment native tissue repair than with the Apogee kit in women with previous posterior compartment native tissue repair (21.2% versus 6.4%; P = 0.03). Only 8% of extrusions/exposures needed revision of the mesh. A set of significant predictors of mesh extrusion/exposure was identified. Overall success rates were 81.4% (110/135) for the Perigee kit and 74.7% (62/83) for the Apogee kit. CONCLUSIONS: This is one of the longest prospective mesh follow-up studies to date from a single centre and highlights the need for continuing surveillance despite high overall success rates.