PROSPECT: 4- and 6-year follow-up of a randomised trial of surgery for vaginal prolapse

Fiona M. Reid*, Lorna Aucott, Cathryn M.A. Glazener, Andrew Elders, Christine Hemming, Kevin G. Cooper, Robert M. Freeman, Anthony R.B. Smith, Suzanne Hagen, Mary Kilonzo, Dwayne Boyers, Graeme MacLennan, John Norrie, Suzanne Breeman, PROSPECT Study Group

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction and hypothesis
Our aim was to compare the mid-term results of native tissue, biological xenograft and polypropylene mesh surgery for women with vaginal wall prolapse.

Methods
A total of 1348 women undergoing primary transvaginal repair of an anterior and/or posterior prolapse were recruited between January 2010 and August 2013 from 35 UK centres. They were randomised by remote allocation to native tissue surgery, biological xenograft or polypropylene mesh. We performed both 4- and 6-year follow-up using validated patient-reported outcome measures.

Results
At 4 and 6 years post-operation, there was no clinically important difference in Pelvic Organ Prolapse Symptom Score for any of the treatments. Using a strict composite outcome to assess functional cure at 6 years, we found no difference in cure among the three types of surgery. Half the women were cured at 6 years but only 10.3 to 12% of women had undergone further surgery for prolapse. However, 8.4% of women in the mesh group had undergone further surgery for mesh complications. There was no difference in the incidence of chronic pain or dyspareunia between groups.

Conclusions
At the mid-term outcome of 6 years, there is no benefit from augmenting primary prolapse repairs with polypropylene mesh inlays or biological xenografts. There was no evidence that polypropylene mesh inlays caused greater pain or dyspareunia than native tissue repairs.
Original languageEnglish
JournalInternational Urogynecology Journal
Early online date26 Aug 2022
DOIs
Publication statusE-pub ahead of print - 26 Aug 2022

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