Several procedures have been proposed for surgical correction of POP and/or stress urinary incontinence (SUI) using different synthetic meshes such as polypropylene (PP) material. Polyvinylidene fluoride (PVDF) meshes have been proven to have higher biocompatibility, reduced morbidity, and less inflammatory and fibrotic reactions compared to PP meshes. Here, we presented a two-year follow-up report of patients who had undergone transvaginal surgery using PVDF meshes to correct POP and concomitant SUI.

peri or post-menopausal women with high grade anterior compartment prolapse and concomitant SUI,  non-responsive to conservative management, were scheduled for double sling surgery using four-arm PVDF mesh. The vaginal symptoms, intensity, and type of urinary incontinence and prolapse stage were recorded preoperatively using International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS), International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF), and Pelvic Organ Prolapse Quantification (POP-Q) system, respectively. All surgeries were done by one experienced urologist. The surgical procedure steps were as follows: first, via a 3-cm vertical anterior vaginal wall incision, anterior arms of the mesh implemented through craniocaudal retro-pubic approach. Next, sacrospinous ligament fixation through  trans-obturator root was done by using posterior arms of the PVDF mesh. Then central part of the four-arm mesh fixed to arcus tendinous of endopelvic fascia and uterosacral ligament with absorbable suture material. After that, double layer vaginal wall epithelium closed with overlap technique. Finally, the mesh properly adjusted to prevent over-correction. The patients were followed up for at least 24 months

From 2015 to 2019, we prospectively enrolled a total of 38 women with a mean (±SD) age of 58.91(±10.73) years, complaining of SUI and concomitant POP. There was a statistically significant improvement after two years (p-value: 0.029) regarding the vaginal symptom score. No significant mesh-related complications, including vaginal mesh exposure or migration to the bladder, urethra, no urethral injury or sever vaginal bleeding  were detected during operation or the follow-up period. During the six and 12-month follow-up visits, only one patient reported persistent pelvic pain (2.6%). Persistent urinary retention, defined as the inability to voluntarily pass urine or a sense of incomplete emptying was observed in 2 (5.26%) of the participants. Early postoperative vaginal bleeding was noted in 10.52% of patients. Postoperative complications included SUI recurrence (15.78%), the need for further anti-incontinence surgery (10.52%), de novo urge urinary incontinence (7.8%), temporary urinary retention after discharge from the hospital (7.89%), and recurrent urinary tract infections (21.05%). No mesh-related complications, such as infection, vaginal mesh exposure, mesh protrusion to the bladder, urethra, or dyspareunia, were detected during a mean follow-up period of 42 months (ranging 24-60 months).

To the best of our knowledge, this is the first paper reporting the mid-term subjective and objective outcomes of POP repair with PVDF mesh in a double sling procedure through trans-obturator and retro-pubic routes using validated questionnaires and regular genital exams. The promising result of no mesh-related complications in our study can be attributed to the use of a very short anterior wall incision and damage of the vaginal mucosa, the implementation of an overlap technique in the closure of the vaginal wall, and using a relatively biocompatible implant. Regarding de novo urge urinary incontinence, only three patients with a previous history of diabetes mellitus and herniation of the lumbar disk experienced this situation, which was managed with oral anticholinergics. we reported persistent urinary retention in 5.26% of the patients, which is expected in POP surgeries regardless of the mesh material.

Double sling with PVDF implant is safe and feasible for select women with high grade anterior compartment prolapse and concomitant symptomatic SUI.