Performance of Tension Free Vaginal Mesh (Prolift) Versus Conventional Vaginal Prolapse Surgery in Recurrent Prolapse.

• Prolapse by POPQ, at entry, after 6 months, after 12 months
• Prolapse complaints by standardised questionnaire, at entry, after 6 months, after 12 months
• Quality of life by standardised questionnaire, at entry, after 6 months, after 12 months

• Complications during the procedure, after 6 weeks, after 6 months, after 12 months [ Time Frame: during procedure, after 6 weeks, 6 months and 12 months ] [ Designated as safety issue: Yes ]
• Quality of life by standardised questionnaire, at entry, after 6 months, after 12 months [ Time Frame: at entry, after 6 months and 12 months ] [ Designated as safety issue: No ]
• prolapse complaints by standardised questionnaires [ Time Frame: at entry, after 6 weeks, 6 months and 12 months ] [ Designated as safety issue: No ]

Pelvic organ prolapse is a common problem. A lot of women have surgery for prolapse. The recurrence rate op pelvic organ prolapse after surgical treatment is high. Placement of a mesh aims at reducing the recurrence rate, but mesh implants can cause complications.

This study is designed to determine the effectiveness of one type of mesh (tensionfree vaginal mesh; Prolift), compared with the standard prolapse surgery. A secondary objective is to track the complications of both procedures.

Patients with recurrent prolapse after surgery can participate in this study. A total of 194 women will be included. At random 97 patients undergo a standard prolapse operation and 97 patients undergo an operation with the mesh. Evaluation will take place during surgery, at the postoperative visit after six weeks, and after six months and twelve months. Quality of life, degree of vaginal prolapse, subjective effectiveness, safety and incidence of complications will be evaluated.

• Procedure: Tensionfree vaginal mesh (Prolift)
  surgery with Prolift mesh
• Procedure: classic vaginal prolapse surgery (fascia plication)
  classic surgery, fascia plication

• Experimental: 1
  Tensionfree vaginal mesh (Prolift)
  Intervention: Procedure: Tensionfree vaginal mesh (Prolift)
• Active Comparator: 2
  classic vaginal prolapse surgery (fascia plication)
  Intervention: Procedure: classic vaginal prolapse surgery (fascia plication)

• Withagen MI, Milani AL, de Leeuw JW, Vierhout ME. Development of de novo prolapse in untreated vaginal compartments after prolapse repair with and without mesh: a secondary analysis of a randomised controlled trial. BJOG. 2012 Feb;119(3):354-60. doi: 10.1111/j.1471-0528.2011.03231.x.
• Withagen MI, Milani AL, den Boon J, Vervest HA, Vierhout ME. Trocar-guided mesh compared with conventional vaginal repair in recurrent prolapse: a randomized controlled trial. Obstet Gynecol. 2011 Feb;117(2 Pt 1):242-50.

Inclusion Criteria:

• recurrent anterior and/or posterior prolapse POP-Q stage 2 or more
• patient has agreed to undergo implantation of TVM (prolift) or fascial plication
• patient is willing to return for follow-up evaluation at 6 weeks, 6 months and 12 months
• patient is willing to complete quality of life questionnaires at 6 and 12 months

Exclusion Criteria:

• patient is or wants to become pregnant
• patient has had previous synthetic mesh procedure (a previous mid-urethral sling procedure is NOT an exclusion criterion)
• patient has current urinary tract or vaginal infections
• patient has a blood coagulation disorder
• patient has a compromised immune system or any other condition that would compromise healing
• patient has renal insufficiency and/or upper urinary tract obstruction
• patient is unwilling or unable to return for evaluation
• patient has had previous irradiation
• patient has any malignancy
• patient has large ovarian cysts of large myoma