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Prospective analysis of transvaginal mesh hysteropexy in the treatment of uterine prolapse

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Abstract

Introduction and hypothesis

The aim of this study was to assess the efficacy of using transvaginal mesh to correct uterine prolapse by hysteropexy.

Methods

This was a single-center, prospective study of 40 subjects with bothersome uterine prolapse. Inclusion criteria were bothersome perception of a vaginal bulge on Pelvic Floor Distress Inventory short form (PFDI-20) and having a Pelvic Organ Prolapse Quantification System (POP-Q) point C of −2 or worse. Exclusionary criteria included inability to consent, history of pelvic malignancies, or any prior prolapse repair. Eligible subjects were treated with transvaginal mesh hysteropexy between March 2016 and July 2018 for a primary outcome of composite success, which was defined by a POP-Q point C value of −2 or higher, PFDI−20 question 3 indicating no bothersome perception of prolapse, and no retreatment. Secondary outcomes included responses to condition-specific and quality-of-life questionnaires, satisfaction/regret, and complications.

Results

Transvaginal mesh hysteropexy was performed in 40 subjects. The majority (68%) had advanced stage (III/IV) uterine prolapse. At a median follow-up of 12 months, there was an 84% composite success, and considering only anatomic criteria (POP-Q point C < –1), there was a 92% success. No subject required reintervention for recurrent or persistent uterine prolapse. There were no cases of mesh exposures. In terms of safety, one subject required a blood transfusion for symptomatic anemia (Clavien-Dindo grade II), and one subject reported de novo dyspareunia from a perineal band that was released in office at 6 months (grade IIIa), but otherwise there were no serious immediate or late complications. There were significant improvements in both condition-specific and quality-of-life assessments from baseline. Subject satisfaction and acceptance for the procedure were high.

Conclusions

In this single-center case series of 40 women with bothersome uterovaginal prolapse, transvaginal mesh hysteropexy appears safe and effective for correcting advanced stage uterine prolapse at the short term. A future multicenter controlled trial would be needed to determine efficacy against native tissue repair.

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Authors and Affiliations

  1. Advanced Urogynecology of Michigan, P.C, Dearborn, MI, USA

    Salil Khandwala & Jason Cruff

  2. Beaumont Health, Wayne, MI, USA

    Salil Khandwala & Jason Cruff

Authors
  1. Salil Khandwala
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  2. Jason Cruff
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Contributions

S. Khandwala: Project/protocol development, manuscript writing/editing.

J. Cruff: Data collection, data analysis, manuscript writing/editing.

Corresponding author

Correspondence to Jason Cruff.

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Financial disclaimers/conflict of interest statement

Dr. Khandwala is a consultant for Boston Scientific, Coloplast, and Medtronics. He is also an expert witness in the Johnson and Johnson medicolegal multidistrict litigation. Dr. Cruff has no conflicts of interest. Funding was provided through an Investigator-Initiated Study program by Coloplast Inc. (Humlebaek, Denmark). Coloplast, however, had no role in the study design, data analysis, or writing of the manuscript.

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Khandwala, S., Cruff, J. Prospective analysis of transvaginal mesh hysteropexy in the treatment of uterine prolapse. Int Urogynecol J 32, 2241–2247 (2021). https://doi.org/10.1007/s00192-020-04590-0

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  • DOI: https://doi.org/10.1007/s00192-020-04590-0

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