Efficacy and safety of transvaginal mesh kits in the treatment of prolapse of the vaginal apex: a systematic review.

BACKGROUND: Vaginal mesh kits are being used to surgically treat apical vaginal prolapse; however, their safety and efficacy are currently unknown. OBJECTIVES: To summarise success and complication rates for commonly used vaginal mesh kits in the treatment of apical prolapse. SEARCH STRATEGY: MEDLINE and other scientific databases were queried for primary research addressing the use of vaginal mesh kits for apical prolapse published between 1950 and 2007, including abstracts presented in major scientific meetings. SELECTION CRITERIA: Studies describing the use of mesh to support either the anterior or posterior compartment alone, for incontinence or fistula repair or not addressing the vaginal apex were excluded. DATA COLLECTION AND ANALYSIS: Identified studies were grouped by the mesh kit and complications categorised using the Dindo classification system. Weighted averages and confidence intervals were calculated on objective success, follow-up length and complications. MAIN RESULTS: Thirty studies totalling 2653 women met inclusion criteria. Objective success rates (95% CI) were Apogee (American Medical Systems Inc., Minnetonka, MN, USA) 95% (95-96), Prolift (Ethicon Women's Health and Urology, Somerville, NJ, USA) 87% (86-87) and posterior intravaginal slingplasty 88% (87-89). Reoperations not requiring anaesthesia (Dindo IIIa) occurred in 0.4-2.3% and requiring anaesthesia (Dindo IIIb) in 1.5-6.0%, with a follow up between 26 and 78 weeks. Mesh erosion was the most commonly reported complication occurring in 4.6-10.7%. AUTHOR'S CONCLUSIONS: Overall objective success using transvaginal mesh kits in restoring apical vaginal prolapse is high. However, an increasing number of women require surgical intervention for mesh-related complications based on limited data quality and short follow up. Further research addressing functional outcomes and the impact of these procedures on women's symptoms and quality of life is mandatory.

Duke Scholars

Author John E Jelovsek Obstetrics and Gynecology, Urogynecology