Transvaginal Mesh Surgery Is Sufficient to Repair Pelvic Organ Prolapse Compared to Laparoscopic Sacrocolpopexy: A Propensity Score Matching Analysis
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Purpose: Both laparoscopic sacrocolpopexy (LSC) and transvaginal mesh surgery (TVM) may provide favorable outcomes for patients with pelvic organ prolapse (POP). However, in our experience, LSC tends to be performed for severe POP and TVM for POP of a moderate or earlier stage. This study aimed to examine the postoperative results of the 2 groups including the preoperative parameters as closely as possible. Methods: We retrospectively evaluated 238 patients with POP who underwent LSC or TVM at National Defense Medical College Hospital between September 2014 and January 2024. In our hospital, 94 patients were treated by LSC, whereas 144 were treated by TVM. After using nearest-neighbor propensity score matching, the surgical outcomes were compared between the matched 76 patients treated with LSC and 76 treated with TVM. Results: To perform nearest-neighbor propensity score matching, the body mass index (BMI), POP stage, and number of laparotomies were used as explanatory variables. After propensity score matching, no significant differences in BMI, POP stage, and number of previous laparotomies were found between the matched LSC and TVM groups. Significant differences in age, blood loss, and operating time still existed even after propensity score matching. No significant differences in the occurrence of urinary incontinence or mesh exposure or prolapse recurrence were found between the matched LSC and TVM groups in all patients and patients with stage 4 POP. Moreover, no significant differences in the time to prolapse recurrence or urinary incontinence were found between the matched LSC and TVM groups (P=0.627 and P=0.235, respectively). Conclusions: Based on the analysis using nearest-neighbor propensity score matching, both surgical methods were effective treatment approaches of POP. TVM would be sufficient to treat POP given its shorter operative time and low complication rates.
Abstract
Purpose: Both laparoscopic sacrocolpopexy (LSC) and transvaginal mesh surgery (TVM) may provide favorable outcomes for patients with pelvic organ prolapse (POP). However, in our experience, LSC tends to be performed for severe POP and TVM for POP of a moderate or earlier stage. This study aimed to examine the postoperative results of the 2 groups including the preoperative parameters as closely as possible. Methods: We retrospectively evaluated 238 patients with POP who underwent LSC or TVM at National Defense Medical College Hospital between September 2014 and January 2024. In our hospital, 94 patients were treated by LSC, whereas 144 were treated by TVM. After using nearest-neighbor propensity score matching, the surgical outcomes were compared between the matched 76 patients treated with LSC and 76 treated with TVM. Results: To perform nearest-neighbor propensity score matching, the body mass index (BMI), POP stage, and number of laparotomies were used as explanatory variables. After propensity score matching, no significant differences in BMI, POP stage, and number of previous laparotomies were found between the matched LSC and TVM groups. Significant differences in age, blood loss, and operating time still existed even after propensity score matching. No significant differences in the occurrence of urinary incontinence or mesh exposure or prolapse recurrence were found between the matched LSC and TVM groups in all patients and patients with stage 4 POP. Moreover, no significant differences in the time to prolapse recurrence or urinary incontinence were found between the matched LSC and TVM groups (P=0.627 and P=0.235, respectively). Conclusions: Based on the analysis using nearest-neighbor propensity score matching, both surgical methods were effective treatment approaches of POP. TVM would be sufficient to treat POP given its shorter operative time and low complication rates.