Mesh procedures not recommended for primary prolapse repair | Lancet

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Takeaway 

  • Mesh procedures for incontinence are associated with a lower risk for complications and subsequent surgery than open colposuspension.
  • Mesh procedures for anterior and posterior compartment prolapse are associated with poor outcomes and complications compared with non-mesh repairs.

Why this matters 

  • Concerns have been raised about the safety of surgery for stress urinary incontinence and pelvic organ prolapse using transvaginal mesh.

Key results

  • 16,660 (62%) of 26,885 underwent a first, single incontinence procedure.
  • Compared with non-mesh open surgery (colposuspension), mesh procedures had:

        —   lower risk for immediate complications (adjusted relative risk [aRR], 0.44).

        —   subsequent prolapse surgery (adjusted incidence rate ratio [aIRR], 0.30 for retropubic and 0.26 for transobturator mesh).

        —   further incontinence surgery admissions (aIRR, 0.90) and later complications (aIRR, 1.12).

  • 18,986 (24.5%) of 77,537 women underwent a first, single prolapse procedure.
  • Compared with non-mesh repair, mesh repair of anterior compartment prolapse was associated with:

        —   similar risk for immediate complications (aRR, 0·93).

        —   an increased risk for further incontinence (aIRR, 3.20), prolapse surgery (aIRR, 1.69) and later complications (aIRR, 3.15).

Study design

  • Population-based cohort study used a national hospital admission database to extract data for all women (age, ≥20 y) who underwent incontinence and prolapse procedures between 1997 and 2016 in Scotland, UK.
  • Funding: None.

Limitations

  • Results restricted to women undergoing first, single incontinence or prolapse procedures.