Prolapse Recurrence after Transvaginal Mesh Removal

Purpose: We determined the rate of pelvic organ prolapse recurrence after transvaginal mesh removal.

Materials and methods: Following institutional review board approval a longitudinally collected database of women undergoing transvaginal mesh removal for complications after transvaginal mesh placement with at least 1 year minimum followup was queried for pelvic organ prolapse recurrence. Recurrent prolapse was defined as greater than stage 1 on examination or the need for reoperation at the site of transvaginal mesh removal. Outcome measures were based on POP-Q (Pelvic Organ Prolapse Quantification System) at the last visit. Patients were grouped into 3 groups, including group 1--recurrent prolapse in the same compartment as transvaginal mesh removal, 2--persistent prolapse and 3--prolapse in a compartment different than transvaginal mesh removal.

Results: Of 73 women 52 met study inclusion criteria from 2007 to 2013, including 73% who presented with multiple indications for transvaginal mesh removal. The mean interval between insertion and removal was 45 months (range 10 to 165). Overall mean followup after transvaginal mesh removal was 30 months (range 12 to 84). In group 1 (recurrent prolapse) the rate was 15% (6 of 40 patients). Four women underwent surgery for recurrent prolapse at a mean 7 of months (range 5 to 10). Two patients elected observation. The rate of persistent prolapse (group 2) was 23% (12 of 52 patients). Three women underwent prolapse reoperation at a mean of 10 months (range 8 to 12). In group 3 (de novo/different compartment prolapse) the rate was 6% (3 of 52 patients). One woman underwent surgical repair at 52 months.

Conclusions: At a mean 2.5-year followup 62% of patients (32 of 52) did not have recurrent or persistent prolapse after transvaginal mesh removal and 85% (44 of 52) did not undergo any further procedure for prolapse. Specifically for pelvic organ prolapse in the same compartment as transvaginal mesh removal 12% of patients had recurrence, of whom 8% underwent prolapse repair.