Related Experiment Video
Updated: Mar 5, 2026
A Novel Surgical Technique in a Sheep Model for Suburethral Graft Implantation
Published on: June 20, 2025
Perioperative morbidity using transvaginal mesh in pelvic organ prolapse repair
Daniel Altman1, Christian Falconer
1Division of Obstetrics and Gynecology, Karolinska Institutet Danderyd Hospital, 182 88 Stockholm, Sweden. daniel.altman@ds.se
Objective:
To describe the perioperative morbidity associated with transvaginal mesh repair of pelvic organ prolapse.
Methods:
During a 6-month time period, 25 centers registered all surgical procedures using a commercially available mesh. The frequency and type of perioperative complications, during surgery and the associated hospital stay, were documented using a standardized protocol.
Results:
During the inclusion period, 248 women underwent transvaginal mesh surgery: anterior repair in 106 patients (43%), posterior repair in 71 (29%), combined anterior and posterior repair in 20 (8%), and total repair in 51 (21%). Mean age was 67.8 years (+/-10.3 standard deviation) and median parity was 2 (range 0-6). Surgery for prolapse recurrence was performed in 56% of the patients (n=140), and 91% (n=225) had undergone at least one previous pelvic floor surgical procedure. Serious complications occurred in 4.4% of patients (n=11) and were dominated by visceral injury (10 of 11 cases). One case of bleeding in excess of 1,000 mL occurred. Minor complications occurred in 14.5% of patients (n=36), and the majority were urinary tract infections, urinary retention, and postoperative fever. A multivariable risk analysis showed that concurrent pelvic floor surgery was associated with an increased risk for minor complications, odds ratio 2.8 (95% confidence interval 1.1-6.9). There were no other predictors of outcomes when assessing the association with age, parity, weight, previous pelvic floor surgery, previous hysterectomy, or concurrent hysterectomy.
Conclusion:
Perioperative serious complications are uncommon after transvaginal mesh procedures although particular care should be taken to detect visceral injury at the time of surgery.
Level Of Evidence:
III.
Insights
Transvaginal mesh repair for pelvic organ prolapse has a low rate of serious perioperative complications. However, visceral injury is a significant concern, necessitating careful surgical technique and monitoring.
Area of Science:
- Urogynecology
- Pelvic Floor Surgery
- Surgical Complications
Background:
- Pelvic organ prolapse (POP) affects a significant number of women.
- Transvaginal mesh repair is a common surgical approach for POP.
- Understanding perioperative morbidity is crucial for patient safety and surgical decision-making.
Purpose of the Study:
- To evaluate the perioperative morbidity associated with transvaginal mesh repair for pelvic organ prolapse.
- To identify the types and frequency of complications during and after surgery.
- To analyze risk factors for perioperative complications.
Main Methods:
- A multicenter study involving 25 centers over a 6-month period.
- Documentation of all transvaginal mesh procedures using a standardized protocol.
- Data collection on perioperative complications during surgery and hospital stay.
Main Results:
- 248 women underwent transvaginal mesh repair for various types of prolapse.
- Serious complications occurred in 4.4% of patients, primarily visceral injuries (10 of 11 cases).
- Minor complications (14.5%) included UTIs, urinary retention, and fever; concurrent pelvic floor surgery increased risk for minor complications.
Conclusions:
- Serious perioperative complications are infrequent following transvaginal mesh repair for POP.
- Vigilance for visceral injury during surgery is essential.
- While overall serious complications are low, minor complications can occur, and concurrent procedures may increase their likelihood.
