Native tissue repairs in anterior vaginal prolapse surgery: Examining definitions of surgical success in the mesh era

PURPOSE OF REVIEW: Native tissue repair of the anterior vaginal wall was thought to have a poor success rate based on anatomic outcome. This high rate of anatomic failure was often quoted as the underlying reason for performing mesh-augmented prolapse repair. The purpose of this article is to review the outcomes of native tissue repair of anterior vaginal prolapse repair in the mesh era. RECENT FINDINGS: Success in pelvic organ prolapse surgery has been redefined. The contemporary definition of success includes the absence of symptoms associated with a vaginal bulge, which correlates best with a patient's perception of success. When this concept is applied to 12 randomized controlled trials that compared native tissue anterior colporrhaphy and mesh repairs for anterior vaginal wall prolapse, it is apparent that although mesh repair had superior anatomic success (38-93 vs. 27-71%), both mesh and native tissue repair had excellent rates of symptomatic success (75-96 and 62-100%, respectively). Taken together, the overall reoperation rate for native tissue repair was 5.0% compared with 9.0% for mesh-augmented repair. SUMMARY: Although anatomic stage 0 results are not achieved in many cases, patients do experience symptomatic relief and improvement in their quality of life, only seeking retreatment in a small proportion of cases with anatomic recurrence. Thus, the definition of success must include subjective symptom-based outcome in addition to anatomic outcome. In addition, the degree of later complications, including additional surgeries, must also be taken into account when defining success based on patient satisfaction.