Pelvic organ prolapse(POP) develops when tissues that support the pelvic floor loosen or collapse as a result of aging, childbirth, and obesity. There are treatment options such as lifestyle changes, drug therapy, laser therapy, pessaries, and surgery, but surgery is only fundamental treatment. About 11.1% of women by the age of 80 years have undergone surgical intervention for POP and surgeries for posterior vaginal wall prolapse have been reported to account for half of POP surgery. One of the surgical treatment has been transvaginal mesh (TVM), however, in modern, a consensus has emerged that polypropylene mesh should not be used for posterior vaginal wall and mesh-free vaginal wall repair has generally been chosen. Moreover, one of the reasons for the consensus not to use mesh for posterior vaginal wall prolapse is the possibility of mesh exposure and chronic pain, which are mesh complications due to PP mesh. In Japan polytetrafluoroethylene (PTFE) mesh ORIHIME🄬 could be used for TVM surgery since 2018.  ORIHIME🄬 is a stable material that does not decompose in the body and does not cause inflammation so much in the surrounding tissues. As a result, mesh contracture and pain due to chronic inflammation rarely occur.
Aimes of this study is to examine the efficacy and safety of posterior transvaginal mesh (TVM-P) surgery using ORIHIME🄬 for advanced posterior vaginal prolapse.

This is a retrospective cohort study of patients who underwent TVM-P surgery using ORIHIME🄬 for POP-Q stage III or IV posterior vaginal prolapse from December 2018 to March 2023 and were followed up for at least one year after surgery. The primary outcome was to evaluate the recurrence in the operated compartment.  The secondary outcome was to evaluate the recurrence in the other compartments and the rate of mesh-related complications, as well as risk factors for recurrence.

During the study period, 71 patients underwent TVM-P surgery. The mesh shape and mesh shape in the pelvis are showed in the Figure. The surgical outcomes regarding recurrence were showed in the Table. The recurrence rate was 4.2% in the operated compartment and total recurrence rate was 18.3%. Eleven cases of recurrence occurred within one year, and 13 cases within three years. Of the recurrences in the operated compartment, two were classified as stageⅡ and one as stageⅣ. Recurrence in other compartment was classified as POP-Q stageⅡ in two patients, and stageⅢ in eight patients and surgical treatment was performed in all patients that were stageⅢ. We observed no cases of mesh extrusion and defecatory function subjective failure. One patient reported chronic pain. The other compartment recurrence group had significantly more cases of preoperative point Ba≧-1 than the non-recurrence group. Preoperative point Ba≧-1 tended to indicate recurrence in the other compartments (crude odds ratio 4.17, 95% CI: 1.03-26.7 and adjusted odds ratio 2.58, 95% CI: 0.56-11.8 adjusted for age, BMI, and parity)

The recurrence rate in the operated compartment after TVM-P surgery for advanced rectoceles or enteroceles was 4.2%. We observed no cases of mesh extrusion and defecatory function subjective failure.

TVM-P surgery using ORIHIME🄬 should be considered a potentially effective and safe surgical option for severe posterior vaginal pelvic organ prolapse.