Efficacy Study of Vaginal Mesh for Anterior Prolapse

Phase 4

Completed

Conditions: Vaginal Prolapse
Uterine Prolapse
Cystocele
Pelvic Organ Prolapse

Brief Summary: The primary aim of this double-blind, randomized clinical trial (RCT) is to test the hypothesis that the addition of a standardized technique of interpositional synthetic polypropylene mesh placement improves the one-year outcome of vaginal reconstructive surgery for anterior prolapse compared to traditional vaginal reconstructive surgery without mesh.

Detailed Description: Multiple vaginal, abdominal and laparoscopic procedures have been described for surgical correction of pelvic support problems. However, conventional pelvic reconstructive surgeries have been associated with a 20-30% prolapse recurrence rate. The anterior vaginal wall is the site most often recognized as the area of vaginal prolapse recurrence. Minimally invasive surgical procedures using mesh have rapidly developed in the field of pelvic floor reconstruction in an attempt to improve surgical cure rates. Unfortunately, safety and efficacy data have lagged behind the technical advancements.

This trial will randomize women with advanced anterior wall prolapse to two treatment arms: vaginal reconstructive surgery with mesh and vaginal reconstructive surgery without mesh. The primary outcome is cure of anterior wall prolapse at one year. Secondary outcomes are cure of apical and posterior wall prolapse, quality-of-life measures and complication rates. Patients will be approached for recruitment only after they have made the decision to undergo vaginal surgery for anterior prolapse. The patient and examiner will be blinded to the surgical treatment assignment. Interim measurement of primary and secondary outcomes will be conducted three months post-operatively. Additional follow-up will be conducted at one-year intervals subsequent to the expected one-year endpoint.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Uterus in place.
No anterior vaginal prolapse.
Medical contraindications, e.g. current urinary tract, vaginal or pelvic infection, history of pelvic irradiation, history of lower urinary tract malignancy, chronic steroid use or a compromised immune system.
Current intermittent self catheterization.
Pregnancy or desire for future fertility.
Presence of an adnexal or ovarian mass.
Shortened vagina.
Other laparoscopic or abdominal/pelvic surgery in the past 3 months.*
Known neurologic or medical condition affecting bladder function, e.g. multiple sclerosis, spinal cord injury.
Need for surgery requiring an abdominal incision.
<12 months post-partum. (Enrollment can be deferred until time requirement has been met).

Arm && Interventions

Group	Intervention	Description
no mesh	synthetic polypropylene mesh	Vaginal reconstructive surgery without mesh
mesh	synthetic polypropylene mesh	Vaginal reconstructive surgery with synthetic polypropylene mesh

Primary Outcome Measures

Name	Time	Method
The Primary Outcome Measure for Objective Treatment Success is Anterior Prolapse, Point Ba at Stage 0 or 1 (Defined as Maximal Descent of the Anterior Wall to Greater Than 1 cm Above the Hymen) at One Year.	1 year

Secondary Outcome Measures