Adverse events after surgical procedures for pelvic floor disorders. In Scotland, Morling and colleagues performed a retrospective observational cohort study of first-time surgeries for SUI (mesh or colposuspension; 16,660 procedures) and prolapse (mesh or native tissue; 18,986 procedures).
After 5 years of follow-up, women who underwent midurethral mesh sling placement or colposuspension had similar rates of repeat surgery for recurrent SUI (adjusted incidence rate ratio, 0.90; 95% CI, 0.73–1.11). Use of mesh slings was associated with fewer immediate complications (adjusted relative risk, 0.44; 95% CI, 0.36–0.55) compared with nonmesh surgery.
Among women who underwent surgery for prolapse, those who had anterior and posterior repair with mesh experienced higher late complication rates than those who underwent native tissue repair. Risk for subsequent prolapse repair was similar with mesh and native-tissue procedures.
Authors’ commentary. The researchers noted that their data support the use of mesh procedures for incontinence but additional research on longer-term outcomes would be useful. However, for prolapse repair, the study results do not decidedly favor any one vault repair procedure.
WHAT THIS EVIDENCE MEANS FOR PRACTICEThese studies highlight the prevalence of pelvic floor disorders and underscore the need for evidence-based treatment strategies. Women with symptomatic pelvic floor disorders initially should be offered conservative options and education. Although mesh grafts certainly have expanded the surgical options for managing pelvic floor disorders, they should be used with caution transvaginally for primary prolapse repairs. Because of the complexity of POP and its treatment, it is reasonable to refer patients with the condition to a specialist experienced in female pelvic medicine and reconstructive surgery.
--Meadow M. Good, DO
--Meadow M. Good, DO
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