The Outcomes of Genital Prolapse after Surgical Management Using Transvaginal Mesh-Two Years Experience

Introduction Pelvic organ prolapses (POP) is an important health problem due to its debilitating effects, with a life-long risk for surgery estimated at 7-19%. Over the years transvaginal mesh surgery for anterior vaginal wall prolapse has become the first line treatment due to its numerous advantages and good results when compared with classic prolapse surgery. However, this type of surgery is not without complications, some of them having a negative impact on the patient's life. Materials and methods Over a period of two years we have performed 84 procedures for anterior vaginal wall prolapse using transobturator four arms polypropylene mesh. All of the patients that were included in this study have had at least stage two anterior vaginal wall prolapse, with bothersome symptoms, and some of them have had pervious surgery for POP or stress urinary incontinence. The preoperative evaluation included physical examination, urinalysis, bladder ultrasound with measurement of postvoid residuum and evaluation of the symptoms, quality of life and sexuality using self-administered questionnaires (Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire and Pelvic Organ Prolapse-Urinary Incontinence-Sexual Questionnaire). Postoperative evaluation was made periodically at 4 weeks, 3, 6 and 12 months and afterwards annually where it was possible. Results Anatomical success was achieved in 81 cases (96,42%) and 3 patients (3,57%) presented relapse at 6 months after surgery. Only 5 patients (5,95%) complained of dyspareunia after surgery, despite the fact that initially there were 40 patients (47,61%) who accused dyspareunia. Significant improvements have been achieved regarding urinary symptoms complaints. In the postoperative period we have encountered 8 patients (9,52%) with vaginal erosion, 5 patients (5,9%) with mesh exposure, 3 cases (3,57%) of de novo dyspareunia and 7 patients with chronic pelvic discomfort. The scores of the questionnaires used for the evaluation of the symptoms, quality of life and sexuality were significantly improved after surgery and the subjective success rate was 91,8%. Conclusions The transvaginal mesh approach that we have used in the management of anterior vaginal wall prolapse has showed good results and has demonstrated to be a viable alternative to traditional anterior colporrhapy. The results of our study have proven to be in line with the results published by other authors. We consider that if this type of procedure is done by a highly qualified and experienced physician the risk of complications can be significantly reduced.