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Updated: Sep 20, 2025
Transvaginal Mesh Insertion in the Ovine Model
Published on: July 27, 2017
Transvaginal Mesh Compared With Native Tissue Repair for Pelvic Organ Prolapse
Bruce Kahn1, R Edward Varner, Miles Murphy
1Department of Obstetrics & Gynecology, Scripps Clinic, San Diego, California; Division of Women's Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama; the Institute for Female Pelvic Medicine & Reconstructive Surgery, North Wales, Pennsylvania; the Department of Obstetrics and Gynecology, University of Chicago Pritzker School of Medicine, Chicago, and the Division of Urogynecology, Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Winnetka, Illinois; the American Association of Female Pelvic Medicine Specialists, Inc., Westlake Village, California; the, Department of Family Medicine, University of Southern California, Westlake Village, California; the Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics and Gynecology, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, New Jersey; the Department of Urology, Columbia University Irving Medical Center, New York, New York; the Department of Urology, West Chester Hospital, West Chester Township, and the Division of Urology, Department of Surgery, University of Cincinnati College of Medicine Cincinnati, Ohio; and Division of Urogynecology and Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, School of Medicine, University of California, Irvine, Orange, California.
Objective:
To compare the safety and effectiveness of transvaginal mesh repair and native tissue repair, in response to a U.S. Food and Drug Administration (FDA) 522 study order to assess co-primary endpoints of superiority and noninferiority.
Methods:
This was a prospective, nonrandomized, parallel cohort, multi-center trial comparing transvaginal mesh with native tissue repair for the treatment of pelvic organ prolapse. The primary endpoints were composite treatment success at 36 months comprised of anatomical success (defined as pelvic organ prolapse quantification [POP-Q] point Ba≤0 and/or C≤0), subjective success (vaginal bulging per the PFDI-20 [Pelvic Floor Distress Inventory]), and retreatment measures, as well as rates of serious device-related or serious procedure-related adverse events. Secondary endpoints included a composite outcome similar to the primary composite outcome but with anatomical success defined as POP-Q point Ba<0 and/or C<0, quality-of-life measures, mesh exposure and mesh- and procedure-related complications. Propensity score stratification was applied.
Results:
Primary endpoint composite success at 36 months was 89.3% (201/225) for transvaginal mesh and 80.2% (389/485) for native tissue repair, demonstrating noninferiority at the preset margin of 12% (propensity score-adjusted treatment difference 6.5%, 90% CI -0.2% to 13.2%). Using the primary composite endpoint, transvaginal mesh was not superior to native tissue repair (P=.056). Using the secondary composite endpoint, superiority of transvaginal mesh over native tissue repair was noted (P=.009), with a propensity score-adjusted difference of 10.6% (90% CI 3.3-17.9%) in favor of transvaginal mesh. Subjective success for both the primary and secondary endpoint was 92.4% for transvaginal mesh, 92.8% for native tissue repair, a propensity score-adjusted difference of -4.3% (CI -12.3% to 3.8%). For the primary safety endpoint, 3.1% (7/225) of patients in the transvaginal mesh (TVM) group and 2.7% (13/485) of patients in the native tissue repair (NTR) group developed serious adverse events, demonstrating that transvaginal mesh was noninferior to native tissue repair (-0.4%, 90% CI -2.7% to 1.9%). Overall device-related and/or procedure-related adverse event rates were 35.1% (79/225) in the TVM group and 46.4% (225/485) in the NTR group (-15.7%, 95% CI -24.0% to -7.5%).
Conclusion:
Transvaginal mesh repair for the treatment of anterior and/or apical vaginal prolapse was not superior to native tissue repair at 36 months. Subjective success, an important consideration from the patient-experience perspective, was high and not statistically different between groups. Transvaginal mesh repair was as safe as native tissue repair with respect to serious device-related and/or serious procedure-related adverse events.
Funding Source:
This study was sponsored by Boston Scientific and developed in collaboration with FDA personnel from the Office of Surveillance and Biometrics, Division of Epidemiology.
Clinical Trial Registration:
ClinicalTrials.gov, NCT01917968.
