Retrospective study of tension-free vaginal mesh operation outcomes for prognosis improvement.

Aim The aim of this study is to look at the weak points of tension-free vaginal mesh (TVM) operation for pelvic organ prolapse by reviewing recurrent cases. Methods Five hundred and twenty-six transobturator TVM operations were performed at the University of Occupational and Environmental Health hospital from August 2006 to December 2011. Thirty-seven patients with pelvic organ prolapse quantification (POP-Q) stage II or higher after their initial operations were diagnosed as recurrent and were enrolled in the present study. The patients' characteristics, procedures of the initial and second operations, and the recurrence rates in the pelvic organs were retrospectively reviewed. Results The median age, parity and body mass index of the patients were 66.5years (range, 48-80), 2.2-times (range, 1-5) and 24.1kg/m2 (range, 17.6-32.1), respectively. The mean/median follow-up periods of the whole group were 29.7/35.9months and the recurrent prolapse rate was 7.0% (37/526 cases). We performed reoperations in eight cases (8/526 cases; 1.5%). The median recurrent period after the initial operations was 6.9months (range, 1-24). All recurrent cases showed severe prolapse with POP-Q stage III to IV before the initial operations. The uterus showed the most frequent recurrent prolapse after anterior posterior TVM or anterior TVM. Conclusion Because the uterus is the most recurrent organ after TVM operations, TVM operations may not be sufficient for apical suspension.