Complications and effectiveness at 3 years in women treated for pelvic organ prolapse with transvaginal mesh repair: results from the PRIMES Registry in China.

Abstract

Transvaginal mesh (TVM) repair for pelvic organ prolapse (POP) is controversial. Although the US FDA ordered manufacturers to stop selling TVM products for POP in 2019, synthetic mesh continues to be used for selected patients in parts of East Asia, Latin America, and Europe. In 2020, the Chinese Urogynaecology and Reconstructive Pelvic Surgery Association updated the indications for TVM to (1) recurrent POP; or (2) patients aged 60 years or older diagnosed with severe primary POP particularly anterior compartment prolapse who have low or no sexual activity and cannot tolerate abdominal repair surgery. This nationwide prospective registry evaluated 3-year complications and effectiveness of TVM in women meeting the updated indications. From July 1, 2019, to December 31, 2021, 3847 consecutive women undergoing TVM repair with lightweight mesh by experienced grade IV surgeons at 103 tertiary centres were registered. The mean age was 68.8 years (SD 5.7; range 60 to 90). At 3-year follow-up (84.2% completed), mesh exposure occurred in 2.8% (95% CI 2.2% to 3.5%), with high rates of anatomic cure (95.3%), subjective success (94.1%), composite surgical success (90.1%), and patient satisfaction (98.2%), respectively. Among women who resumed sexual activity and provided relevant follow-up data, 53.1% reported dyspareunia. In conclusion, among highly selected women with POP who met the updated indications, TVM repair using lightweight mesh and performed by experienced surgeons was associated with low mesh exposure rates and sustained effectiveness at 3 years. These observational registry findings may inform individualized decision-making for this defined patient subgroup.