21 Dec Study Finds No Clear Benefit of Mesh For Prolapse Surgery
MedicalResearch.com Interview with:
Prof. Cathryn Glazener
Prof. Cathryn Glazener PhD
Health Services Research Unit
University of Aberdeen
Aberdeen,UK
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Prolapse is a condition that affects up to half of all women after childbirth. Women notice a bulge or discomfort in their vaginas due to pressure from the bladder, bowel or womb moving downwards. Women who have surgery for their prolapse have a 3 in 10 chance of needing at least one more operation, so the success rate is not great. Gynaecologists hoped that by reinforcing their repairs the success rate would get better.
PROSPECT was a pragmatic, multicentre randomised controlled trial conducted in 35 centres across the UK. Women undergoing their first operation for prolapse were randomised to having a standard repair of the front or back wall of the vagina, or a repair reinforced by synthetic non-absorbable mesh, or a biological graft.
We found that, in contrast to previous research, women were just as likely to be cured after standard surgery rather than reinforced repairs. They were just as likely to have other symptoms such as bladder or sexual problems, and other adverse effects such as infection, bleeding or pain.
However, about 1 in 10 of the women who had mesh did have mesh exposure when a small portion of the mesh becomes visible through the vaginal wall. Although many women did not have symptoms, about half of those women needed a small operation to remove or bury the exposed mesh.
MedicalResearch.com: What should readers take away from your report?
Response: There were no clear benefits from the use of mesh or graft over a standard repair in women having their first operation.
However, synthetic mesh did result in some complications which posed extra risk.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: No surgery is without risk, and surgery for prolapse remains less effective than for other conditions such as urinary leakage. Researchers and clinicians need to work together to identify better operations, or to reduce the prolapse symptoms using other means.
MedicalResearch.com: Is there anything else you would like to add?
Response: Two other papers published in the Lancet today have drawn attention to other aspects of care for women with pelvic floor dysfunction. Researchers from the Information Services Division have shown that long term results from mesh prolapse surgery are no better than from standard repair, echoing the PROSPECT findings. The PrevProl study showed that pelvic floor exercises should be tried as a first line as they have been shown to reduce prolapse symptoms or prevent their progression, at least in the short term. Women can also reduce risk factors such as obesity, heavy lifting and chronic cough.
Prevention and conservative treatment such as using pessaries can also avert or delay surgery. However, if these fail, women should be reassured that if they do need surgery, they ought to go ahead with standard operations, while being aware of the risks and chance of failure.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Citation:
Mesh, graft, or standard repair for women having primary transvaginal anterior or posterior compartment prolapse surgery: two parallel-group, multicentre, randomised, controlled trials (PROSPECT)
Glazener, Cathryn MA et al.
The Lancet , Volume 0 , Issue 0 ,
DOI: http://dx.doi.org/10.1016/S0140-6736(16)31596-3
Published: 20 December 2016
Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.
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Last Updated on December 21, 2016 by Marie Benz MD FAAD