Randomized controlled trial comparing two procedures for anterior vaginal wall prolapse.

OBJECTIVE: To compare success rates between anterior colporrhaphy and abdominal paravaginal defect repair for treatment of anterior vaginal wall prolapse.

METHODS: This was a prospective randomized controlled trial comparing anterior colporrhaphy plus polyglactin 910 mesh (vaginal) to paravaginal defect repair (abdominal) in women with symptomatic anterior vaginal wall prolapse. Pelvic organ prolapse quantification staging (POP-Q), pelvic floor distress inventory, pelvic floor impact questionnaire, and pelvic organ prolapse/urinary incontinence sexual questionnaires were administered pre and post-operatively. Women were followed up to 2 years. The primary outcome was anterior POP-Q stage, with failure defined as ≥stage II.

RESULTS: We enrolled 70 patients, 35 in each group. Demographic and most peri-operative characteristics were similar between the groups. Mean anterior vaginal wall prolapse repair time (39 min) was shorter for vaginal versus abdominal repair (60 min; P < 0.001), with more concurrent hysterectomies in the vaginal (71%) versus abdominal group (42%), P = 0.01. At 2 years, objective failure rates for the vaginal and abdominal groups were 32% and 40%, respectively, P = 0.56. Subjective failure rates were lower and similar for both groups. Patient satisfaction rates were 88% for the vaginal and 73% for the abdominal group, P = 0.11. Quality of life questionnaires showed significant improvement from baseline but no difference between the groups (P = 0.12).

CONCLUSIONS: At 2 years follow-up, anterior colporrhaphy with polyglactin 910 mesh and abdominal paravaginal defect repair have similar success rates, with most objective failures being asymptomatic.