Mesh inlay, mesh kit or native tissue repair for women having repeat anterior or posterior prolapse surgery: randomised controlled trial (PROSPECT)

PROSPECT study group

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To compare standard (native tissue) repair against synthetic mesh inlays or mesh kits.

DESIGN: Randomised controlled trial.

SETTING: 33 UK hospitals.

POPULATION: Women having surgery for recurrent prolapse.

METHODS: Women recruited using remote randomisation.

MAIN OUTCOME MEASURES: Prolapse symptoms, condition specific quality-of-life and serious adverse effects.

RESULTS: Mean Pelvic Organ Prolapse Symptom Score at 1 year was similar for each comparison (standard 6.6 versus mesh inlay 6.1, mean difference (MD) -0.41, 95% CI [-2.92 to 2.11]: standard 6.6 versus mesh kit 5.9, MD -1.21 [-4.13 to 1.72]) but the confidence intervals did not exclude a minimally important clinical difference. There was no evidence of difference in any other outcome measure at 1 or 2 years. Serious adverse events, excluding mesh exposure, were similar at 1 year (standard 7/55 [13%] versus mesh inlay 5/52 [10%], risk ratio [RR] 1.05, [0.66 to 1.68]: standard 3/25 [12%] versus mesh kit 3/46 [7%], RR 0.49, [0.11 to 2.16]). Cumulative mesh exposure rates over 2 years were 7/52 (13%) in the mesh inlay arm, of whom four women required surgical revision; and 4/46 in the mesh kit arm (9%) of whom two required surgical revision.

CONCLUSIONS: We did not find evidence of a difference in terms of prolapse symptoms from the use of mesh inlays or mesh kits in women undergoing repeat prolapse surgery. Although the sample size was too small to be conclusive, the results provide a substantive contribution to future meta-analysis.

Original languageEnglish
JournalBJOG-An International Journal of Obstetrics and Gynaecology
Early online date6 Apr 2020
DOIs
Publication statusE-pub ahead of print - 6 Apr 2020

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Keywords

  • pelvic organ prolapse
  • repeat surgery
  • randomised controlled trial
  • sythentic mesh
  • Pelvic organ prolapse
  • synthetic mesh

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

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