To evaluate the 3-year complications and effectiveness of transvaginal mesh (TVM) repair in women with the updated indications of recurrent pelvic organ prolapse (POP), or severe primary POP in women aged 60 years or older, particularly in the anterior compartment.

DESIGN
Nationwide prospective cohort study.
SETTING
103 tertiary centres in China.
PARTICIPANTS
Women undergoing TVM repair who were consecutively registered in the Chinese Pelvic Floor Reconstruction Surgery with Implants/Mesh Registry (PRIMES) and met the updated indications for TVM repair were included in this study.
INTERVENTIONS
TVM repair.
MAIN OUTCOME MEASURES
The primary outcome was mesh exposure at three years. Secondary outcomes were perioperative and other postoperative complications, anatomic cure, subjective success, composite surgical success, and patient-reported outcomes. The crude cumulative incidence of mesh exposure and other key outcomes was calculated as the proportion of patients experiencing an event at each follow-up visit.

From 1 July 2019 to 31 December 2021, women undergoing TVM repair were consecutively registered in PRIMES. Of these, 3847 met the updated indications and were included for analysis; mean age was 68.8 years, and 615 (16.0%) were sexually active. 176 surgeons qualified for grade IV (most complex operation in Chinese Classification) gynaecological surgery completed TVM operations using lightweight mesh products. At three-year follow-up (84.2% completed), mesh exposure was 2.8% (95% CI, 2.2% to 3.5%), with high rates of anatomic cure (95.3%; 95% CI, 94.4% to 96.0%), subjective success (94.1%; 95% CI, 93.2% to 94.9%), composite surgical success (90.1%; 95% CI, 89.0% to 91.1%), and patient satisfaction (98.2%; 95% CI, 97.6% to 98.6%). 70.3% of mesh exposures were minor (less than 1 cm), and 41.6% of patients were asymptomatic.

Among women with POP who met updated indications for TVM repair, lightweight mesh TVM repair was associated with low mesh exposure rates and durable effectiveness at 3 years. These findings provide prospective evidence to inform individualized clinical decision-making, particularly for sexually inactive women and those with recurrent or severe primary prolapse when surgery is performed by experienced surgeons.

International academic societies recently recommended a nuanced approach on TVM rather than a wholesale ban. We provide strong evidence that for carefully selected patients, TVM repair performed by experienced surgeons with light-weight mesh is a safe and effective option, offering sustained benefits that appear to outweigh the low long-term risk of complications.

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Acs J, Szabo A, Fehervari P, et al. Safety and Efficacy of Vaginal Implants in Pelvic Organ Prolapse Surgery: A Meta-analysis of 161 536 Patients. Eur Urol Focus 2024;10(4):525-34.
Menefee SA, Richter HE, Myers D, et al. Apical Suspension Repair for Vaginal Vault Prolapse: A Randomized Clinical Trial. JAMA Surg 2024;159(8):845-55. doi: 10.1001/jamasurg.2024.1206.

Continence 19S (2026) 102574
DOI: 10.1016/j.cont.2026.102574