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Long-term outcomes of vaginal mesh versus native tissue repair for anterior vaginal wall prolapse

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Abstract

Introduction and hypothesis

To estimate the risk of repeat surgery for recurrent prolapse or mesh removal after vaginal mesh versus native tissue repair for anterior vaginal wall prolapse.

Methods

We utilized longitudinal, adjudicated, healthcare claims from 2005 to 2010 to identify women ≥18 years who underwent an anterior colporrhaphy (CPT 57420) with or without concurrent vaginal mesh (CPT 57267). The primary outcome was repeat surgery for anterior or apical prolapse or for mesh removal/revision; these outcomes were also analyzed separately. We utilized Kaplan–Meier curves to estimate the cumulative risk of each outcome after vaginal mesh versus native tissue repair. Cox proportional hazards models were used to estimate the hazard ratio (HR) for vaginal mesh versus native tissue repair, adjusted for age, concurrent hysterectomy, and concurrent or recent sling.

Results

We identified 27,809 anterior prolapse surgeries with 49,658 person-years of follow-up. Of those, 6,871 (24.7%) included vaginal mesh. The 5-year cumulative risk of any repeat surgery was significantly higher for vaginal mesh versus native tissue (15.2 % vs 9.8 %, p <0.0001) with a 5-year risk of mesh revision/removal of 5.9%. The 5-year risk of surgery for recurrent prolapse was similar between vaginal mesh and native tissue groups (10.4 % vs 9.3 %, p = 0.70. The results of the adjusted Cox model were similar (HR 0.93, 95%CI: 0.83, 1.05).

Conclusions

The use of mesh for anterior prolapse was associated with an increased risk of any repeat surgery, which was driven by surgery for mesh removal. Native tissue and vaginal mesh surgery had similar 5-year risks for surgery for recurrent prolapse.

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Funding

This project was supported by grant number K02HS017950 from the Agency for Healthcare Research and Quality (AHRQ; to M.J.F) and grant number K23HD068404 from the Eunice Kennedy Shriver National Institute of Child Health & Human Development (to J.M.W). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, USA

    Michele Jonsson Funk & Virginia Pate

  2. Center for Women’s Health Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Michele Jonsson Funk

  3. Division of Urogynecology, Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA

    Anthony G. Visco, Alison C. Weidner & Jennifer M. Wu

  4. Duke University Medical Center, Box 3192, 5324 McFarland Avenue, Suite 310, Durham, NC, 27707, USA

    Jennifer M. Wu

Authors
  1. Michele Jonsson Funk
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  2. Anthony G. Visco
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  3. Alison C. Weidner
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  4. Virginia Pate
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  5. Jennifer M. Wu
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Corresponding author

Correspondence to Jennifer M. Wu.

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Jonsson Funk, M., Visco, A.G., Weidner, A.C. et al. Long-term outcomes of vaginal mesh versus native tissue repair for anterior vaginal wall prolapse. Int Urogynecol J 24, 1279–1285 (2013). https://doi.org/10.1007/s00192-013-2043-9

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  • DOI: https://doi.org/10.1007/s00192-013-2043-9

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