Prolapse recurrence, methods of reoperation, and long-term mesh complications: A nationwide follow-up study

Abstract

Introduction: Further prolapse in the same or a different vaginal compartment is common, particularly following native tissue surgery. This study aims to report the rates of reoperations for prolapse and subjective recurrence after native tissue and mesh-augmented surgeries. Additionally, it seeks to describe the methods of repeat surgery for prolapse and to evaluate long-term mesh complications. Material and Methods: This is a follow-up study of the nationwide cohort (ClinicalTrials.gov [NCT02716506]) of pelvic organ prolapse surgeries performed in 2015 in Finland. Prolapse recurrence, reoperations and mesh complications were studied utilizing data from patient questionnaires and the national register. Reoperation rates, timing, methods of repeat surgery, and rates of subjective recurrence were compared among native tissue, transvaginal mesh and abdominal mesh surgeries. Predictive factors for reoperation were studied with logistic regression analysis. Mesh-related complications were evaluated after transvaginal and abdominal mesh repair. Results: The mean follow-up of 3321 women was 7.4 years, during which 443 (13%) underwent reoperation for prolapse; 13.9% after native tissue, 10.1% after transvaginal mesh, and 12.1% after abdominal mesh repair (p = 0.09). Up to one third of women reported symptoms of vaginal bulging during follow-up, with significantly lower rates after transvaginal mesh surgery at 2- and 5-year follow-ups. The majority of reoperations for prolapse were single-site; anterior or apical repair was most common after native tissue and abdominal mesh surgery, while reoperations after transvaginal repair involved mainly posterior or apical compartments. Mesh was used in 40% of all reoperations. Prolapse surgery involving both posterior and apical compartments was the only factor associated with increased risk for reoperation (aOR 1.95 CI 1.30–2.92). Only 1.6% of women had a surgically treated mesh complication based on the register data, while the rates of patient-reported mesh exposures and mesh-related reoperations were 6.5% and 6.4%, with no significant difference between the two mesh groups. Conclusions: The long-term risk of reoperation for prolapse was similar after native tissue and mesh-augmented surgery, while the site of reoperation differed based on the type of surgical treatment. Mesh complication rates were similar after transvaginal and abdominal mesh repair, and the majority of mesh exposures did not require surgical treatment.