Satisfaction and Decisional Regret After Mesh Versus Non-Mesh Apical Pelvic Organ Prolapse Surgery

Pelvic organ prolapse (POP) is a common condition that can have a significant impact on a woman's quality of life. While surgical success is often measured objectively, patient-centered metrics are equally important.

This study investigated satisfaction, decisional regret, and sexual function in patients who underwent POP surgery with or without mesh to better understand how patients define success.

This is a retrospective review of patients who underwent apical POP surgery from 2015 to 2023 at a single institution serving an ethnically diverse community. Demographic data were collected through chart review and surveys conducted via telephone calls. Patient satisfaction and decisional regret were measured with the validated modified Satisfaction with Decision Scale-Decision Regret Scale for pelvic floor disorders. Sexual function after surgery was measured with the validated 6-question Female Sexual Function Index and open-ended sexual health questions. Patients were compared by use of mesh during surgery (e.g., sacrocolpopexy) versus native tissue repair. Fischer's exact test was used to compare categorical variables and t-tests used to compare continuous variables with p < 0.05 as significant.

Of the 250 women contacted who underwent POP surgery between 2015 and 2023, 110 (44%) participated, with a median follow-up of 970 days (IQR 843). Forty (36%) and 70 (64%) patients underwent mesh versus native tissue repair, respectively. There were no significant differences in satisfaction (p = 0.52) and regret (p = 0.83) between mesh and non-mesh groups. Patients who experienced moderate-to-severe decisional regret were significantly more likely to report regret regarding undergoing hysterectomy (p = 0.03) and not having had mesh placed at the time of their POP surgery (p < 0.01), compared to those with mild regret. Fifteen patients (16%) reported sexual health concerns, which were significantly associated with lower satisfaction (p < 0.01).

Patients who underwent POP surgery had low regret and high satisfaction with their decision at almost 3 years of follow-up. Regret and satisfaction did not significantly differ based on the use of mesh. Although overall regret was low, open-ended responses revealed nuanced concerns about hysterectomy, mesh, and sexual health, suggesting limitations of current assessment tools. Overall, this study highlights how patient-centered metrics could augment the determination of surgical success and better inform decision-making in patients considering POP surgery.