The emergence of complications associated with the use of mesh in pelvic organ prolapse (POP) repair has raised concerns regarding this surgical approach, leading to more restricted indications [1]. The primary aim of this study was to evaluate the long-term outcomes and complications of POP repair using different types of transvaginal mesh (TVM).

We conducted a single-center retrospective review of patients undergoing TVM repair for primary or recurrent apical POP since 2007. POP staging was performed using the Baden-Walker classification. Indications for TVM included symptomatic POP (grade ≥ 2), apical (primary or recurrent), or recurrent anterior/posterior prolapse. Recurrence was classified as either symptomatic or asymptomatic (anatomical, detected only by physical examination). A successful outcome was defined as the absence of both clinical and anatomical recurrence. Subjective long-term patient satisfaction with surgery was assessed using a 0-10 scale and with the Treatment Benefit Scale (TBS). Comparison between mesh types was performed using the Chi-square test for qualitative variables and the Kruskal-Wallis test for quantitative variables.

A total of 83 female patients were included (33 Prolift®, 36 Elevate®, and 14 Surelift®), with a mean age of 67.8 ± 9.7 years. Eighteen patients (21.6%) underwent surgery for recurrent POP. At a mean follow-up of 13.5 years ± 3.4 years, 14 symptomatic recurrences (16.87%) were identified, 7 of which required further surgery. The mean satisfaction score was 8.43/10, and the mean TBS score was 1.5. Regarding complications, four vaginal exposures (4.8%) were detected, with two cases requiring partial mesh removal. Additionally, three cases of dyspareunia (3.6%) and one case of mild pelvic pain (1.2%) were reported, none of which required further treatment. Forty-four patients were lost to follow-up, including 27 deaths from medical causes unrelated to the POP procedure.

At a mean 13.5-year follow-up, TVM exhibits a good long-term durability and high patient satisfaction (8.4/10). The rates of recurrence and mesh exposure are similar to those previously reported in the literature [2]. Despite limitations regarding loss to follow-up (primarily due to non-procedure-related deaths), these findings demonstrate that it can be a safe and effective procedure for sustained pelvic floor reconstruction [3].

In conclusion, TVM repair for apical or recurrent pelvic organ prolapse is an effective procedure for selected cases, associated with high patient long-term satisfaction rates and low complication rate, which were primarily managed in an outpatient setting.

Barski D, Otto T, Gerullis H. Systematic review and classification of complications after anterior, posterior, apical, and total vaginal mesh implantation for prolapse repair. Surg Technol Int. 2014;24:217-24.
Welk B, Dmochowski R, McCarthy K, Keck J, Mourad S, Hashim H. Complications associated with the use of mesh to treat female urinary incontinence and pelvic organ prolapse. Continence. 2024;12:101713.
Mateu Arrom L, Errando Smet C, Gutierrez Ruiz C, et al. Pelvic Organ Prolapse Repair with Mesh: Mid-Term Efficacy and Complications. Urol Int. 2018;101(2):201-205. doi:10.1159/000489636.