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PROSPECT: 4- and 6-year follow-up of a randomised trial of surgery for vaginal prolapse
Open accessAbstract
Introduction and hypothesis: Our aim was to compare the mid-term results of native tissue, biological xenograft and polypropylene mesh surgery for women with vaginal wall prolapse. Methods: A total of 1348 women undergoing primary transvaginal repair of an anterior and/or posterior prolapse were recruited between January 2010 and August 2013 from 35 UK centres. They were randomised by remote allocation to native tissue surgery, biological xenograft or polypropylene mesh. We performed both 4- and 6-year follow-up using validated patient-reported outcome measures. Results: At 4 and 6 years post-operation, there was no clinically important difference in Pelvic Organ Prolapse Symptom Score for any of the treatments. Using a strict composite outcome to assess functional cure at 6 years, we found no difference in cure among the three types of surgery. Half the women were cured at 6 years but only 10.3 to 12% of women had undergone further surgery for prolapse. However, 8.4% of women in the mesh group had undergone further surgery for mesh complications. There was no difference in the incidence of chronic pain or dyspareunia between groups. Conclusions: At the mid-term outcome of 6 years, there is no benefit from augmenting primary prolapse repairs with polypropylene mesh inlays or biological xenografts. There was no evidence that polypropylene mesh inlays caused greater pain or dyspareunia than native tissue repairs.
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In the PROSPECT study, using a composite outcome assessing functional cure, half of the women were reported as not cured but only 10%-12% had undergone further prolapse surgery.
“Using a composite outcome assessing functional cure, half of the women were reported as not cured but only 10%–12% had undergone further prolapse surgery.”
From How Can We Improve the Assessment and Indifferent Outcomes From Pelvic Organ Prolapse Management From Conservative and Surgical Therapies? ICI‐RS 2025 (2026) · cites this paper as [4]
In the PROSPECT study of 1348 women with vaginal prolapse, at 4 and 6 years, the prolapse symptom score was better in women who had native tissue surgery compared to polypropylene mesh.
“For example, the randomised PROSPECT study, comparing the use of native tissue, biological xenograft, and polypropylene mesh surgery in 1348 women with vaginal prolapse, reported at 4 and 6 years that the prolapse symptom score was better in women who had native surgery compared to polypropylene mesh [4].”
From How Can We Improve the Assessment and Indifferent Outcomes From Pelvic Organ Prolapse Management From Conservative and Surgical Therapies? ICI‐RS 2025 (2026) · cites this paper as [4]
The use of synthetic mesh was introduced to reduce recurrence but has not had the desired effect and has been associated with significant complications.
“The use of synthetic mesh was introduced in an attempt to reduce recurrence, but this has not had the desired effect and has been associated with significant complications.”
From How Can We Improve the Assessment and Indifferent Outcomes From Pelvic Organ Prolapse Management From Conservative and Surgical Therapies? ICI‐RS 2025 (2026) · cites this paper as [4]
In the PROSPECT study, 8.4% of women in the polypropylene mesh group had undergone further surgery for mesh-related complications.
“In addition, 8.4% of women in the polypropylene mesh group had undergone further surgery for mesh‐related complications.”
From How Can We Improve the Assessment and Indifferent Outcomes From Pelvic Organ Prolapse Management From Conservative and Surgical Therapies? ICI‐RS 2025 (2026) · cites this paper as [4]
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Metadata
- Authors
- Reid, F. M., Aucott, L., Glazener, C. M. A., Elders, A., Hemming, C., Cooper, K. G., Freeman, R. M., Smith, A. R. B., Hagen, S., Kilonzo, M., Boyers, D., MacLennan, G., Norrie, J., Breeman, S., & for the PROSPECT study group
- Affiliations
- Manchester Academic Health Science Centre (GB)
- University of Aberdeen (GB)
- Glasgow Caledonian University (GB)
- Aberdeen Royal Infirmary (GB)
- Plymouth Hospital (GB)
- University of Edinburgh (GB)
- Corresponding author
- Reid, Fiona M.
- ORCID
- Venue
- International Urogynecology Journal
- Published
- 2022-08-26
- Volume
- 34
- Issue
- 1
- Pages
- 67-78
- ISSN
- 0937-3462 (ISSN-L)
- 1433-3023
- PMC
- PMC9834125
- OpenAlex
- W4293124689
- Cited by
- 18
- References
- 20
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 7 · 2023: 3
- FWCI
- 2.55
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- International Urogynecology Journal (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ResearchOnline (acceptedVersion, cc-by)
- ResearchOnline (Glasgow Caledonian University) (submittedVersion, cc-by)
- Aberdeen University Research Archive (Aberdeen University) (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion, other-oa)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
- Funders
- Scottish Government
- National Institute for Health and Care Research (07/60/18)
- Department of Health and Social Care
- Chief Scientist Office, Scottish Government Health and Social Care Directorate
- Topics
- Health Sciences › Medicine › Urology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Surgery › Hernia repair and management
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Keywords
- vaginal wall prolapse, transvaginal repair, native tissue repair, polypropylene mesh, pelvic organ prolapse, functional cure, mesh complications, chronic pain, dyspareunia, patient-reported outcomes, mid-term outcomes
- MeSH terms
- Dyspareunia, Female, Follow-Up Studies, Humans, Polypropylenes, Gynecologic Surgical Procedures, Surgical Mesh, Uterine Prolapse, Treatment Outcome, Pelvic Organ Prolapse
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