Outcomes and predictors of failure of trocar-guided vaginal mesh surgery for pelvic organ prolapse

Published:February 10, 2012DOI:


      The objective of the study was to compare the 1 year conventional and composite outcomes of trocar-guided vaginal mesh surgery and the identification of the predictors of failure.

      Study Design

      This was a prospective observational cohort study. Failure outcome definitions were as follows: I, prolapse stage II or greater in mesh treated compartments; II, overall prolapse stage II or greater; III, composite outcome of overall prolapse greater than the hymen and the presence of bulge symptoms or repeat surgery. We used logistic regression to identify predictors of failure.


      The results of the study were 1 year follow-up of 433 patients. Treated compartment failure (I) was 15% (95% confidence interval [CI], 12–19). Overall prolapse failure (II) was 41% (95% CI, 36–45). Composite failure (III) was 9% (95% CI, 7–13). Predictor of failure in all outcomes was the combined anterior/posterior mesh with the uterus in situ.


      Outcome of prolapse surgery depends on outcome definition. The mesh treated compartment failure outcome (I) and the composite failure outcome (III) appeared not to be statistically different. Consistent factor for failure in all outcomes was the combined anterior/posterior mesh insertion with the uterus in situ.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Maher C.M.
        • Feiner B.
        • Baessler K.
        • Glazener C.M.
        Surgical management of pelvic organ prolapse in women: the updated summary version Cochrane review.
        Int Urogynecol J. 2011; 22: 1445-1457
        • Smith F.J.
        • Holman C.D.
        • Moorin R.E.
        • Tsokos N.
        Lifetime risk of undergoing surgery for pelvic organ prolapse.
        Obstet Gynecol. 2010; 116: 1096-1100
        • de Boer T.A.
        • Slieker-Ten Hove M.C.
        • Burger C.W.
        • Kluivers K.B.
        • Vierhout M.E.
        The prevalence and factors associated with previous surgery for pelvic organ prolapse and/or urinary incontinence in a cross-sectional study in The Netherlands.
        Eur J Obstet Gynecol Reprod Biol. 2011; 158: 343-349
        • Altman D.
        • Vayrynen T.
        • Engh M.E.
        • Axelsen S.
        • Falconer C.
        Anterior colporrhaphy versus transvaginal mesh for pelvic-organ prolapse.
        N Engl J Med. 2011; 364: 1826-1836
        • Weber A.M.
        • Walters M.D.
        • Piedmonte M.R.
        • Ballard L.A.
        Anterior colporrhaphy: a randomized trial of three surgical techniques.
        Am J Obstet Gynecol. 2001; 185 (discussion 1304-6): 1299-1304
        • Sivaslioglu A.A.
        • Unlubilgin E.
        • Dolen I.
        A randomized comparison of polypropylene mesh surgery with site-specific surgery in the treatment of cystocoele.
        Int Urogynecol J Pelvic Floor Dysfunct. 2008; 19: 467-471
        • Nguyen J.N.
        • Burchette R.J.
        Outcome after anterior vaginal prolapse repair: a randomized controlled trial.
        Obstet Gynecol. 2008; 111: 891-898
        • Withagen M.I.
        • Milani A.L.
        • den Boon J.
        • Vervest H.A.
        • Vierhout M.E.
        Trocar-guided mesh compared with conventional vaginal repair in recurrent prolapse: a randomized controlled trial.
        Obstet Gynecol. 2011; 117: 242-250
        • Milani A.L.
        • Withagen M.I.
        • Schweitzer K.J.
        • Janszen E.W.
        • Vierhout M.E.
        Midline fascial plication under continuous digital transrectal control: which factors determine anatomic outcome?.
        Int Urogynecol J Pelvic Floor Dysfunct. 2010; 21: 623-630
        • Weber A.M.
        • Abrams P.
        • Brubaker L.
        • et al.
        The standardization of terminology for researchers in female pelvic floor disorders.
        Int Urogynecol J Pelvic Floor Dysfunct. 2001; 12: 178-186
        • Bump R.C.
        • Mattiasson A.
        • Bo K.
        • et al.
        The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction.
        Am J Obstet Gynecol. 1996; 175: 10-17
        • Barber M.D.
        • Brubaker L.
        • Nygaard I.
        • et al.
        Defining success after surgery for pelvic organ prolapse.
        Obstet Gynecol. 2009; 114: 600-609
        • Swift S.E.
        • Tate S.B.
        • Nicholas J.
        Correlation of symptoms with degree of pelvic organ support in a general population of women: what is pelvic organ prolapse?.
        Am J Obstet Gynecol. 2003; 189 (discussion 377-9): 372-377
        • Withagen M.I.
        • Vierhout M.E.
        • Milani A.L.
        Does trocar-guided tension-free vaginal mesh (Prolift) repair provoke prolapse of the unaffected compartments?.
        Int Urogynecol J Pelvic Floor Dysfunct. 2010; 21: 271-278
        • Whiteside J.L.
        • Barber M.D.
        • Paraiso M.F.
        • Hugney C.M.
        • Walters M.D.
        Clinical evaluation of anterior vaginal wall support defects: interexaminer and intraexaminer reliability.
        Am J Obstet Gynecol. 2004; 191: 100-104
        • Salvatore S.
        • Athanasiou S.
        • Digesu G.A.
        • et al.
        Identification of risk factors for genital prolapse recurrence.
        Neurourol Urodyn. 2009; 28: 301-304
        • Fatton B.
        • Amblard J.
        • Debodinance P.
        • Cosson M.
        • Jacquetin B.
        Transvaginal repair of genital prolapse: preliminary results of a new tension-free vaginal mesh (Prolift technique)—a case series multicentric study.
        Int Urogynecol J Pelvic Floor Dysfunct. 2007; 18: 743-752
        • Collinet P.
        • Belot F.
        • Debodinance P.
        • Ha Duc E.
        • Lucot J.P.
        • Cosson M.
        Transvaginal mesh technique for pelvic organ prolapse repair: mesh exposure management and risk factors.
        Int Urogynecol J Pelvic Floor Dysfunct. 2006; 17: 315-320
        • Withagen M.I.
        • Milani A.L.
        Which factors influenced the result of a tension free vaginal tape operation in a single teaching hospital?.
        Acta Obstet Gynecol Scand. 2007; 86: 1136-1139
        • Milani A.L.
        • Hinoul P.
        • Gauld J.M.
        • Sikirica V.
        • van Drie D.
        • Cosson M.
        Trocar-guided mesh repair of vaginal prolapse using partially absorbable mesh: 1 year outcomes.
        Am J Obstet Gynecol. 2011; 204: 74.e1-74.e8
        • van der Vaart C.H.
        • de Leeuw J.R.
        • Roovers J.P.
        • Heintz A.P.
        Measuring health-related quality of life in women with urogenital dysfunction: the urogenital distress inventory and incontinence impact questionnaire revisited.
        Neurourol Urodyn. 2003; 22: 97-104
        • van Raalte H.M.
        • Lucente V.R.
        • Molden S.M.
        • Haff R.
        • Murphy M.
        One-year anatomic and quality-of-life outcomes after the Prolift procedure for treatment of posthysterectomy prolapse.
        Am J Obstet Gynecol. 2008; 199: 694.e1-694.e6
        • Milani A.L.
        • Withagen M.I.
        • Vierhout M.E.
        Trocar-guided total tension-free vaginal mesh repair of post-hysterectomy vaginal vault prolapse.
        Int Urogynecol J Pelvic Floor Dysfunct. 2009; 20: 1203-1211
        • Peduzzi P.
        • Concato J.
        • Kemper E.
        • Holford T.R.
        • Feinstein A.R.
        A simulation study of the number of events per variable in logistic regression analysis.
        J Clin Epidemiol. 1996; 49: 1373-1379
        • Antosh D.D.
        • Iglesia C.B.
        • Vora S.
        • Sokol A.I.
        Outcome assessment with blinded versus unblinded POP-Q exams.
        Am J Obstet Gynecol. 2011; 205: 489.e1-489.e4
        • Chmielewski L.
        • Walters M.D.
        • Weber A.M.
        • Barber M.D.
        Reanalysis of a randomized trial of 3 techniques of anterior colporrhaphy using clinically relevant definitions of success.
        Am J Obstet Gynecol. 2011; 205: 69.e1-69.e8
        • Swift S.
        • Woodman P.
        • O'Boyle A.
        • et al.
        Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects.
        Am J Obstet Gynecol. 2005; 192: 795-806
        • Trowbridge E.R.
        • Fultz N.H.
        • Patel D.A.
        • DeLancey J.O.
        • Fenner D.E.
        Distribution of pelvic organ support measures in a population-based sample of middle-aged, community-dwelling African American and white women in southeastern Michigan.
        Am J Obstet Gynecol. 2008; 198: 548.e1-548.e6
        • Slieker-ten Hove M.C.
        • Pool-Goudzwaard A.L.
        • Eijkemans M.J.
        • Steegers-Theunissen R.P.
        • Burger C.W.
        • Vierhout M.E.
        The prevalence of pelvic organ prolapse symptoms and signs and their relation with bladder and bowel disorders in a general female population.
        Int Urogynecol J Pelvic Floor Dysfunct. 2009; 20: 1037-1045
        • de Landsheere L.
        • Ismail S.
        • Lucot J.P.
        • Deken V.
        • Foidart J.M.
        • Cosson M.
        Surgical intervention after transvaginal Prolift mesh repair: retrospective single-center study including 524 patients with 3 years' median follow-up.
        Am J Obstet Gynecol. 2012; 206: 83.e1-83.e7
        • Withagen M.I.
        • Milani A.L.
        • de Leeuw J.W.
        • Vierhout M.E.
        Development of the novo prolapse in untreated vaginal compartments after prolapse repair with and without mesh: a secondary analysis of a randomized controlled trial.
        BJOG. 2012; 119: 354-360
        • Lowder J.L.
        • Park A.J.
        • Ellison R.
        • et al.
        The role of apical vaginal support in the appearance of anterior and posterior vaginal prolapse.
        Obstet Gynecol. 2008; 111: 152-157
        • Dietz V.
        • de Jong J.
        • Huisman M.
        • Schraffordt Koops S.
        • Heintz P.
        • van der Vaart H.
        The effectiveness of the sacrospinous hysteropexy for the primary treatment of uterovaginal prolapse.
        Int Urogynecol J Pelvic Floor Dysfunct. 2007; 18: 1271-1276
        • Feiner B.
        • Gietelink L.
        • Maher C.
        Anterior vaginal mesh sacrospinous hysteropexy and posterior fascial plication for anterior compartment dominated uterovaginal prolapse.
        Int Urogynecol J Pelvic Floor Dysfunct. 2010; 21: 203-208
        • Benson A.D.
        • Kramer B.A.
        • Wayment R.O.
        • Schwartz B.F.
        Supracervical robotic-assisted laparoscopic sacrocolpopexy for pelvic organ prolapse.
        JSLS. 2010; 14: 525-530
        • Elmer C.
        • Altman D.
        • Engh M.E.
        • Axelsen S.
        • Vayrynen T.
        • Falconer C.
        Trocar-guided transvaginal mesh repair of pelvic organ prolapse.
        Obstet Gynecol. 2009; 113: 117-126
        • Caquant F.
        • Collinet P.
        • Debodinance P.
        • et al.
        Safety of trans vaginal mesh procedure: retrospective study of 684 patients.
        J Obstet Gynaecol Res. 2008; 34: 449-456
        • Withagen M.I.
        • Vierhout M.E.
        • Hendriks J.C.
        • Kluivers K.B.
        • Milani A.L.
        Risk factors for exposure, pain, and dyspareunia after tension-free vaginal mesh procedure.
        Obstet Gynecol. 2011; 118: 629-636
        • US Foods and Drug Administration
        Medical devices.
        (Accessed Sept. 1, 2011)