Transvaginal repair of anterior and posterior compartment prolapse with Atrium polypropylene mesh

Objective To determine the efficacy and safety of a new technique using Atrium polypropylene mesh (Atrium, Hudson, New Hampshire, USA) as an overlay graft for repair of large or recurrent anterior and posterior compartment prolapse. Design A retrospective review of women who had vaginal prolapse surgery with Atrium mesh reinforcement. Setting Tertiary referral urogynaecology unit in Australia. Population Forty-seven women where mesh was placed under the bladder base with lateral extensions onto the pelvic sidewall, 33 women where a Y-shaped mesh was placed from the sacrospinous ligaments to the perineal body and 17 women who had mesh placement in both compartments. Methods Women were assessed by site-specific vaginal examination pre-operatively and post-operatively at six weeks, six months and two years. Main outcome measures All complications. Rate of recurrent prolapse assessed by the Baden-Walker halfway classification system. Results Mean follow up was 29 months (range 6 to 52). Four of 64 women with anterior mesh placement (6%) developed a grade 2 asymptomatic cystocele. Five women (5%) required further surgery for recurrent prolapse at a non-mesh site. Erosion occurred in nine women (9%). Three healed after intravaginal oestrogen cream, five after excision of exposed mesh and vaginal closure and one woman also had surgical closure of a rectovaginal fistula. The risk of mesh erosion decreased over the study period. Urinary, coital and bowel symptoms were significantly improved following surgery. Conclusions This technique shows promise in correcting pelvic organ prolapse. Vaginal mesh erosion is the most common complication and is related to surgical experience.