The use of vaginal mesh for pelvic organ prolapse (POP) repair is one of the most debatable topics. However, for women with anterior vaginal prolapse and less intercourse desire, vaginal mesh provides good support to the structure, short surgical time, and tolerable complications. DynaMesh® - PR4 is made of polyvinylidene fluoride (PVDF) monofilament, with good biocompatibility and material purity. This study is conducted to evaluate the safety and efficacy of transvaginal POP repair using DynaMesh®-PR4 by a modified technique (combined trans-obturator and sacrospinous fixation).

Instead of the original surgical procedure of DynaMesh-PR4 mesh, which applied the four arms of the mesh from the incision at the anterior vaginal wall to the obturator foramen, we modified the penetration method of the posterior arms. In brief, a middle longitudinal incision was made in the anterior vaginal wall from the bladder neck to the vaginal apex. The paravaginal space was dissected to the bilateral ischiorectal fossa with scissors and blunt dissection. The distal mesh was anchored transversally between arcus tendineus with two anterior trocar arms on each side through the obturator foramen. The incisions for trochar of posterior arms are marked at buttock, 3 cm aside from the anus and then 3 cm below bilaterally. The trochar guided the posterior arms of the mesh anchored through the sacrospinous ligaments. After the Dynamesh was fully applied, the mesh was sutured to the anterior vaginal wall and cervix with 2-0 polydioxanone sutures for fixation. The vaginal incision was closed with 2-0 vicryl sutures in double-layer sutured methods. Vaginal perineal urethral suspension, partial trachelectomy, and posterior vaginal wall repair were concomitantly performed if indicated. No estrogen supplement was given for the wound healing process. 

Twenty-four women who underwent pelvic reconstructive surgery with a modified DynaMesh-PR4 for symptomatic anterior or apical prolapse stage II and above from Jan 2020 to Mar 2021 were reviewed retrospectively. The 1-year-outcomes were checked and recorded at the following outpatient department. We retrospectively reviewed the medical records and analyzed the prognosis outcomes.

Patient characteristics and perioperative results were listed in Table 1. The mean age of the patients was 66 years old. The mean operative time was 57.7 minutes.
Post-operative complications were rare and mild (Table 2). No mesh protrusion was noted. On average 1-year follow-up, 3 patients (12.5%) had recurrent anterior compartment prolapse, which was all asymptomatic and within hymen. No apical prolapse recurrent was observed after such a modified procedure (Table 3).

With short operation time, low recurrent rate, rare complications, and short hospitalization, pelvic floor reconstructive surgery with modified vaginal mesh procedure (DynaMesh® - PR4) could be an option for women requiring anterior and apical prolapse repair.

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