Transvaginal repair of anterior and posterior compartment prolapse with Atrium polypropylene mesh

TLDR

The study retrospectively evaluated the efficacy and safety of a new Atrium polypropylene mesh overlay graft technique for repairing large or recurrent anterior and posterior compartment prolapse in 47 women at a tertiary urogynaecology unit. Mesh was placed under the bladder base with lateral extensions, as a Y‑shaped graft from sacrospinous ligaments to the perineal body, or in both compartments, and patients were examined pre‑operatively and at 6 weeks, 6 months, and 2 years using the Baden‑Walker halfway classification. At a mean follow‑up of 29 months, 6 % of women developed asymptomatic cystocele, 5 % required additional surgery, 9 % experienced mesh erosion (the most common complication and decreasing over time), and urinary, coital, and bowel symptoms improved significantly.

Abstract

To determine the efficacy and safety of a new technique using Atrium polypropylene mesh (Atrium, Hudson, New Hampshire, USA) as an overlay graft for repair of large or recurrent anterior and posterior compartment prolapse.A retrospective review of women who had vaginal prolapse surgery with Atrium mesh reinforcement.Tertiary referral urogynaecology unit in Australia.Forty-seven women where mesh was placed under the bladder base with lateral extensions onto the pelvic sidewall, 33 women where a Y-shaped mesh was placed from the sacrospinous ligaments to the perineal body and 17 women who had mesh placement in both compartments.Women were assessed by site-specific vaginal examination pre-operatively and post-operatively at six weeks, six months and two years.All complications. Rate of recurrent prolapse assessed by the Baden-Walker halfway classification system.Mean follow up was 29 months (range 6 to 52). Four of 64 women with anterior mesh placement (6%) developed a grade 2 asymptomatic cystocele. Five women (5%) required further surgery for recurrent prolapse at a non-mesh site. Erosion occurred in nine women (9%). Three healed after intravaginal oestrogen cream, five after excision of exposed mesh and vaginal closure and one woman also had surgical closure of a rectovaginal fistula. The risk of mesh erosion decreased over the study period. Urinary, coital and bowel symptoms were significantly improved following surgery.This technique shows promise in correcting pelvic organ prolapse. Vaginal mesh erosion is the most common complication and is related to surgical experience.