Does anchoring vaginal mesh increase the potential for correcting stress incontinence?

Area of Science:

• Urogynecology
• Pelvic Reconstructive Surgery
• Female Pelvic Medicine

Background:

• Pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are common conditions affecting women.
• Transvaginal mesh (TVM) procedures are utilized for POP correction, but efficacy and complication rates vary.
• Mid-urethral anchoring of TVM is explored for improved outcomes in anterior compartment POP and SUI.

Purpose of the Study:

• To evaluate the feasibility and effectiveness of a modified four-arm transvaginal mesh (mTVM) anchored to the mid-urethra.
• To assess the mTVM procedure for correcting anterior compartment POP-Quantification stage II-III (Q II-III) and concomitant genuine SUI.
• To compare the outcomes and complication rates of mTVM with conventional TVM and anterior colporrhaphy.

Main Methods:

• A retrospective analysis of 248 patients with anterior POP (stage II-III) and SUI was conducted.
• Sixty-two patients received the modified TVM (mTVM) anchored to the mid-urethra.
• Historical controls included 124 patients treated with anterior colporrhaphy and 62 with conventional TVM.

Main Results:

• The mTVM group demonstrated high efficacy in improving POP-Q status (96.8%) and anti-SUI rates (96.8%).
• Anchoring the mesh did not increase extrusion rates or de novo urge symptoms.
• The mTVM group showed a more favorable early postoperative complication profile (Clavien-Dindo I-IIIb: 11.5%) compared to the conventional TVM group (p=0.013).

Conclusions:

• Modified TVM surgery with mid-urethral anchoring is an effective treatment for POP and SUI.
• This technique offers a decreased risk of short- and long-term complications.
• The mTVM procedure presents a promising alternative for managing these conditions.