• J Formos Med Assoc · Dec 2019

    Comparative Study Observational Study

    Comparison of clinical outcomes between tailored transvaginal mesh surgery and native tissue repair for pelvic organ prolapse.

    • Ting-Chen Chang, Sheng-Mou Hsiao, Pei-Chi Wu, Chi-Hau Chen, Wen-Yih Wu, and Ho-Hsiung Lin.
    • Department of Obstetrics and Gynecology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
    • J Formos Med Assoc. 2019 Dec 1; 118 (12): 1623-1632.

    Background/PurposeThe most suitable surgical technique for pelvic organ prolapse (POP) remains undetermined. The aim of this study was to compare clinical outcomes of the tailored transvaginal mesh (TVM) surgery and vaginal native tissue repair (NTR) surgery for POP.MethodsBetween November 2011 and August 2014, medical records of 339 women receiving POP surgeries were reviewed.ResultsCompared with the NTR group (n = 169), the use of TVM surgery (n = 170) was a predictor for longer operation time (coefficient = 25.2 min, P < 0.001) and larger blood loss (coefficient = 79.9 mL, P < 0.001) by multivariable analysis. However, a higher recurrence rate of cystoceles (log-rank test, P = 0.001) was found in the NTR group, compared with the TVM group; but not apical prolapse (P = 0.32) or rectocele (P = 0.45). Multivariable analysis revealed that the TVM surgery (hazard ratio = 0.24, 95% confidence interval = 0.09-0.64, P = 0.004) and old age (hazard ratio = 1.07, 95% confidence interval = 1.02-1.11, P = 0.005) were independent predictors for the recurrence of cystoceles. Based on the receiver operating characteristic curve (ROC) analysis, the cut-off age value was 64 years with an ROC area of 0.65. In women with intact uterus (n = 162), the recurrence rate of cystoceles was lower in the TVM group (log-rank test, P = 0.0001), compared with the NTR group. However, there was no between-group difference in the recurrence rate of cystoceles in women with prior or concomitant hysterectomy (n = 177, P = 0.17).ConclusionIn women with intact uterus, the TVM group has a lower recurrence rate of cystoceles than the NTR group. In addition, old age, especially more than 64 years old, is a risk factor for cystocele recurrence.Copyright © 2019. Published by Elsevier B.V.

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