Is mesh better than colporrhaphy for pelvic organ prolapse?

Compared with anterior colporrhaphy, a trocar-guided transvaginal polypropylene mesh repair kit for prolapse of the anterior vaginal wall (cystocele) results in higher short-term success rates, but also higher rates of surgical complications and postoperative adverse events, according to the findings of a multicenter, parallel-group, randomized, controlled trial from Scandinavia.

Researchers from Sweden, Finland, Norway, and Denmark randomly assigned 389 women from 53 clinics to cystocele repair with a mesh kit (the same type used routinely for hernias and incontinence) or to traditional colporrhaphy.

At 1 year, using the Pelvic Organ Prolapse Quantification system, almost twice as many women (60.8%) who were treated with the mesh repair kit were at the anatomical designation of stage 0 (no prolapse) or 1 (position of the anterior vaginal wall more than 1 cm above the hymen) as those who underwent colporrhaphy (34.5%) (absolute difference, 26.3 percentage points; 95% confidence interval [CI], 15.6 to 37.0).

The authors of the study concluded that physicians, in collaboration with their patients, must weigh the risks and benefits of each treatment option.

Altman D, Väyrynen T, Engh ME, Axelsen S, Falconer C, for the Nordic Transvaginal Mesh Group. Anterior colporrhaphy versus transvaginal mesh for pelvic-organ prolapse. N Engl J Med. 2011;364(19):1826-1836.