Late post-surgical complication and reoperation rate after vaginal mesh surgery

Objectives : Although the efficacy of Prolift® System exceeds 90%, prolapse recurrence and other late post-surgical complications may occur. The aim of the study was to assess the reoperation rate in a group of patients who underwent Prolift® System procedure due to advanced pelvic organ prolapse.

Material and methods : One hundred and eighteen patients who underwent reconstructive surgery with Prolift® System due to pelvic organ prolapse were included in the study. Follow-up visits took place 6 weeks and between 3 and 6 as well as 12 months after the primary surgery. Results: Twenty eight patients (23.7%) required an additional operation due to late post-surgical complications: 8 (6.8%) with de novo SUI, 4 (3.4%) with recurrence of SUI, 10 (8.5%) with recurrence of prolapse, 1 (0.8%) with granuloma and 6 (5.1%) with mesh erosions. In 8 patients who developed SUI and in 4 with recurrence of SUI, the IVS 04M surgery was performed. Cervix amputation including posterior colporrhaphy was performed in 9 patients with prolapse recurrence and in one woman sacrocolpopexy was done. In the case of mesh erosion and granuloma formation, partial removal of prosthesis and granuloma tissue was done. Analysis of cases with prolapse recurrence revealed that decrease of urogenital hiatus by additional posterior colporrhaphy can reduce cervix prolapse.

Conclusions : Surgery treatment of genital prolapse with synthetic prostheses interposed by the vaginal route is effective and characterized by a low rate of late post-surgical complications. However, our study shows

a certain number of such complications and the majority of them were de novo SUI and apical prolapse recurrence. Concomitant sling SUI treatment with POP correction is not less effective than midurethral sling alone. More careful diagnosis of possible occult SUI before treatment and concomitant anti-incontinence procedure may reduce the incidence of postoperative urinary incontinence.