Pelvic organ prolapse repair with Prolift® mesh

The long term durability of conventional surgical repair of vaginal prolapse has been questioned in recent years. In a frequently quoted publication Olsen et al.1 estimated that the lifetime risk (up to age 80 years) of undergoing surgery for vaginal prolapse was 11%. Between 29% and 40% of prolapse surgery is for recurrence 1, 2 and in 60% of re-operations the prolapse is at the site of the original procedure.3 There is no widely accepted and standardised technique for the management of recurrent prolapse. Multiple surgical techniques have evolved each supported enthusiastically by their proponents and some of the techniques involve the use of synthetic mesh material. The abdominal sacral colpopexy with mesh is well accepted and has been found to be superior to the vaginal sacrospinous ligament suspension for correcting upper compartment prolapsed.4-6 However, little comparative data are available suggesting the superiority of vaginal prolapse repair with mesh overlay.7-9 Despite this lack of long term data, the use of vaginally implanted mesh to correct the perceived poor durability of conventional surgery is expanding rapidly due to the enthusiastic marketing of surgical mesh kits with a perceived simplicity of use. Currently most information on the outcomes of vaginal surgery with synthetic implants comes from short term follow up 10-12 or exists in non-peer review publications such as conference abstracts.13, 14 This paper describes a prospective cohort study using monofilament polypropylene mesh kits (Gynecare Prolift®, Ethicon, Somerville, NJ, USA) for the management of vaginal prolapse over the first year of implantation including complications, anatomical success rates and functional outcomes using longitudinal QOL data.