A multicenter, randomized, prospective, controlled study comparing sacrospinous fixation and transvaginal mesh in the treatment of posthysterectomy vaginal vault prolapse

• Published in: American journal of obstetrics and gynecology Vol. 207; no. 4; pp. 301.e1 - 301.e7
• Main Authors: Halaska, Michael, MD, PhD, Maxova, Katerina, MD, Sottner, Oldrich, MD, Svabik, Kamil, MD, PhD, Mlcoch, Michal, MD, Kolarik, Dusan, MD, Mala, Ivana, PhD, Krofta, Ladislav, MD, PhD, Halaska, Michael J., MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-10-2012; Elsevier
• Subjects: Aged; Biological and medical sciences; Female; Gynecology. Andrology. Obstetrics; Humans; Hysterectomy - adverse effects; Ligaments - surgery; Medical sciences; Middle Aged; Obstetrics and Gynecology; Pelvic Organ Prolapse - etiology; Pelvic Organ Prolapse - surgery; pelvic organ prolapse quantification prolapse; Prolift; Quality of Life; quality-of-life questionnaires; Recurrence; sacrospinous fixation; Surgical Mesh; Surveys and Questionnaires; Treatment Outcome; Urinary Incontinence, Stress - surgery; Vagina - surgery; quality-of-life questionnaires; Prolift; sacrospinous fixation; pelvic organ prolapse quantification prolapse; Multicenter study; Gynecology; Vagina; Urogenital system diseases; Obstetrics; Prolapse; Prolapsus; Randomization; Fixation; Treatment; Transvaginal route; Clinical trial; Vault; Comparative study
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2012.08.016

Objective The objective of the study was to compare recurrence and complication rates for sacrospinous fixation (SSF) and prolene mesh techniques for the primary treatment of posthysterectomy vaginal vault prolapse. Study Design Patients undergoing surgery for vault prolapse were included in a multicenter, randomized, controlled study comparing SSF or total mesh (Prolift; Gynecare/Ethicon, Somerville, NJ). The examination included pelvic organ prolapse quantification, urodynamics, ultrasound, and quality-of-life (QoL) questionnaires before and 3 and 12 months after surgery. Results Of 168 randomized patients, 83 underwent SSF and 85 mesh repair. Prolapse recurrence after 12 months occurred in 39.4% of the SSF group and in 16.9% of the mesh group ( P = .003). The mesh exposure rate was 20.8%. No difference in QoL improvement as well as of de novo stress urinary incontinence and overactive bladder onset was found. Conclusion Mesh exposure occurrence was balanced against a lower prolapse recurrence rate in the patients undergoing mesh surgery compared with those undergoing SSF.