Long-Term Outcomes of Transvaginal Mesh in Younger Women: A Retrospective Study

Abstract

Introduction and Hypothesis

Despite FDA bans due to safety concerns, transvaginal mesh (TVM) offers lower recurrence rates for pelvic organ prolapse (POP) compared to native tissue repair. Current Chinese guidelines recommend TVM for recurrent or severe POP (POP-Q stage III–IV) in patients over 60 years. However, evidence regarding its long-term outcomes in younger patients (median age ≤ 60 years) remains limited.

Methods

This retrospective study included women who underwent TVM from 2013 to 2023 at a tertiary medical center. Baseline characteristics and perioperative details were extracted from electronic medical records. Follow-up data were collected through telephone interviews and/or in-person examination and questionnaires. Primary outcome was subjective surgical success. Secondary outcomes were quality of life changes and surgery-related adverse events, including mesh exposure, sexual dysfunction, and urinary complications.

Results

Of 728 women who underwent TVM, 140 (median age 56) were analyzed. At the last follow-up with a median of 52 months (IQR 12, 74), all 140 patients (100%) completed telephone questionnaires, while 42 (30.0%) additionally underwent in-person examination. The subjective cure rate was 95.7% (95% CI, 92.3–99.1%). Quality of life significantly improved postoperatively (both PFIQ-7 and PFDI-20 scores, P < 0.001). Only 4.3% (95% CI, 0.9–7.7%) had mesh exposure. Sexual activity and function remained stable, with a low rate of dyspareunia (4.3%).

Conclusions

TVM demonstrate satisfactory clinical results and a low complication rate in women ≤ 60 with severe POP. It does not significantly impair sexual function in patients who remain sexually active postoperatively.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00192-025-06456-9.

Introduction

Pelvic organ prolapse (POP) is a disorder where the pelvic organs and their neighboring structures experience displacement, resulting in both positional and functional abnormalities [1]. This condition not only markedly impairs quality of life but also has considerable psychosocial impacts [2]. The prevalence of POP increases with age. Among urban women in China, the overall prevalence is 9.7%, rising to 26.1% in those over 70 years old [3].

The lifetime risk of surgical intervention for POP in women ranges from 11.0% to 19.0% [4]. Surgical reconstruction for anterior and posterior prolapse mainly comprises traditional surgical repair and graft material implantation. Studies have shown that transvaginal mesh (TVM) is associated with a lower recurrence rate compared to traditional native tissue repair and is also effective in improving pelvic floor dysfunction (PFD) symptoms [5, 6]. TVM addresses pelvic defects and restores vaginal anatomical positioning throughout the pelvis, demonstrating high surgical success rates despite mesh-related complications [7]. Despite widespread controversy following safety warnings issued by the Food and Drug Administration (FDA) regarding its application, TVM continues to be used in regions, including Germany, Asia, and South America [6]. As outlined in the Chinese guideline for the diagnosis and management of POP (2020 version), TVM is recommended for POP recurrence and primary cases at Pelvic Organ Prolapse Quantification (POP-Q) stage III or IV in women over 60, with careful consideration required for sexually active younger patients [8].

However, some patients aged ≤ 60 years still opt for TVM due to the severity of their prolapse symptoms in clinical practice. Given their longer life expectancy, younger patients often have greater physical and social demands, as well as higher expectations for their postoperative quality of life. Currently, there is a paucity of long-term follow-up for patients in this age group. In this study, we focused on women aged 60 years or younger with severe prolapse who underwent TVM to evaluate their postoperative symptomatic improvement, quality of daily life, and sexual recovery through long-term follow-up.

Materials and Methods

This retrospective study was conducted at a single tertiary medical center performing over 800 urogynecological procedures annually. All patients aged ≤ 60 years who underwent TVM between July 2013 and June 2023 with Pelvic Organ Prolapse Quantification (POP-Q) stage III or IV prolapse were enrolled. A flow diagram of patient selection according to the STROBE statement is presented in Fig. 1. Baseline characteristics and perioperative data were extracted from the institution’s electronic medical record system. Concurrent transvaginal repair procedures were performed when clinically indicated. Anti-incontinence surgery was performed in patients with symptomatic urinary incontinence requiring surgical intervention. All surgeries were performed by experienced surgeons having over 20 years of experience. Postoperatively, all patients were offered vaginal topical estrogen therapy at discharge.

Fig. 1.

Patient flow diagram for the analysis of transvaginal mesh (TVM) surgical outcomes. Of 728 patients assessed, 173 met the inclusion criteria of being aged ≤ 60 years with at least one compartment of Pelvic Organ Prolapse Quantification (POP-Q) stage ≥ III. A total of 170 patients entered follow-up, from which 3 were excluded due to specific exclusion criteria. The final analyzed cohort comprised 140 patients. Thirty patients were lost to follow-up or refused to participate

Baseline characteristics included age, body mass index (BMI), parity, menstrual status, POP-Q stage, medical and surgical comorbidities, and concomitant symptoms. Surgical data included mesh type, concurrent procedures, operative duration, blood loss during operation, duration of urinary catheterization, and length of hospital stay. Follow-up was conducted according to a standardized protocol. Patients were advised to return for regular clinic visits at 1 month, 3 months, 6 months, 1 year, and annually thereafter. During these visits, patients underwent physical examinations and POP-Q assessments by experienced urogynecologists, with concurrent completion of standardized questionnaires. For patients unable to attend in-person follow-up, telephone interviews were conducted. These telephone follow-ups were performed by trained personnel who were not involved in the patients’ initial treatment. The primary outcome was subjective prolapse recurrence, defined as a patient-reported sensation of tissue prolapse or vaginal bulging. Secondary outcomes included: (1) mesh exposure/erosion, suspected by patient reports of vaginal bleeding, discharge, or pain and diagnosed upon gynecological examination; (2) urinary complications by patient report; (3) chronic perineal pain persisting for > 3 months; (4) patient satisfaction assessed by the PGI-C; (5) quality of life evaluated by the PFIQ-7 and PFDI-20; and (6) sexual function measured by the PISQ-12. All questionnaires have been validated in the Chinese population.

The Wilcoxon test was utilized according to the distribution of continuous variables. Categorical variables were compared using the chi-square test or Fisher’s exact test, as appropriate. Continuous variables were compared using the Mann–Whitney U test or independent samples t-test based on their distribution. Non-normal variables were reported as median (interquartile range, IQR). All statistical analyses were done with IBM SPSS Statistics for Windows, version 26.0 (IBMCorp., Armonk, USA). A P value of 0.05 or less was considered statistically significant.

All methods employed in this study were conducted in accordance with the relevant guidelines and regulations. This study was approved by the ethics committee of the authors’ affiliated hospital (Approval No. 2023–317). Written informed consent was obtained from all participants in the study.

Results

Of the 170 eligible women enrolled in total, 30 (17.7%) were excluded due to loss to follow-up, resulting in a final cohort of 140 patients. A total of 87 (62.1%) patients had a follow-up period exceeding 3 years, while 53 (37.9%) had a follow-up of less than 3 years. The median follow-up time was 52 months (12, 74). None of the patients reported a history of smoking or alcohol abuse. The baseline characteristics of the study participants and those lost to follow-up are presented in Table 1. Preoperative POP-Q measurements for all patients are detailed in Table S1. Comparative analysis indicated that the two groups were largely comparable across most measured baseline characteristics, implying that any bias introduced by attrition is likely minimal. Among the 140 patients, the majority (89.3%, n = 125) presented with multi-compartment prolapse. Of these, 76 (54.3% of the total cohort) had stage III/IV prolapse in at least two compartments. Isolated single-compartment prolapse of stage III/IV was less common (10.7%, n = 15). Sixteen patients (11.4%) had stage IV prolapse in at least one compartment. Surgical procedures included reconstruction of whole pelvic floor in 67 patients (47.9%), anterior pelvic reconstruction in 68 (48.6%), and posterior pelvic reconstruction in five (3.6%). Perioperative details and types of used mesh kits are detailed in Table 1 as well. No intraoperative complications or short-term postoperative complications requiring intervention (Clavien-Dindo grade II or higher) were observed in the cohort.

Table 1.

Baseline characteristics of patients operated with TVM

	Characteristics	n = 140 (included)	n = 30 (excluded)	P value
Baseline characteristics	Age(years)	56 (54, 58)	56 (54, 57)	0.382
	BMI (kg/m2)	24.03 (22.66, 26.17)	23.27 (20.55, 26.74)	0.203
	Gravidity	3 (2, 5)	3 (2, 5)	0.906
	Parity	2 (1, 2)	2 (1, 3)	0.495
	Eutocia	2 (1, 2)	2 (1, 2)	0.974
	History of POP related surgery, n (%)	5 (3.6%)	0 (0%)	0.588
	History of hysterectomy, n (%)	14 (10.0%)	5 (3.6%)	0.336
Stage of menstruation	Pre-menopause, n (%)	8 (5.7%)	0 (0%)	0.353
	Post-menopause, n (%)	132 (94.3%)	30 (21.4%)
	Menopausal Age	50 (47, 51)	N/A	N/A
Medical-surgical comorbidity	Hypertension, n (%)	29 (20.7%)	4 (2.9%)	0.354
	Diabetes, n (%)	13 (9.3%)	4 (2.9%)	0.502
	Prior malignancy, n (%)	3 (2.1%)	0 (0%)	1.000
	CHD, n (%)	2 (1.4%)	0 (0%)	1.000
Associated symptoms	Dysuria, n (%)	29 (20.7%)	0 (0%)	0.006
	Urinary incontinence, n (%)	31 (22.1%)	6 (4.3%)	0.796
	Incomplete emptying, n (%)	8 (5.7%)	0 (0%)	0.353
	Dyschezia, n (%)	5 (3.6%)	0 (0%)	0.588
	Incontinence of faeces, n (%)	3 (2.1%)	0 (0%)	1.000
Operative details	Operative time (min)	127 (75, 170)	125 (70, 175)	0.877
	Estimated blood loss (mL)	50 (20, 80)	50 (30, 100)	0.498
	Hospital stay (days)	4 (3, 5)	4 (3, 4)	0.048
	Urinary catheterization (days)	3 (2, 4)	2 (2, 3)	0.006
Type of mesh kit brands	TiLOOP® Total 6, n (%)	65 (46.4%)	10 (7.1%)	0.190
	TiLOOP® Total 4, n (%)	36 (25.7%)	14 (10.0%)	0.022
	Avaulta®, n (%)	35 (25.0%)	5 (3.6%)	0.329
	Herniamesh®, n (%)	2 (1.4%)	0 (0%)	1.000
	DynaMesh®, n (%)	2 (1.4%)	1 (0.7%)	0.444
Concomitant surgical procedures	Posterior Colporrhaphy, n (%)	90 (64.3%)	15 (10.7%)	0.144
	Repair of perineum, n (%)	77 (55.0%)	11 (7.9%)	0.068
	Sacrospinous ligament fixation, n (%)	25 (17.9%)	12 (8.6%)	0.008
	Trachelectomy, n (%)	54 (38.6%)	3 (2.1%)	0.003
	Transvaginal hysterectomy, n (%)	14 (10.0%)	3 (2.1%)	1.000
	Plication operation of urethra, n (%)	24 (17.1%)	1 (0.7%)	0.084
	Mid-urethral sling (TVT-E & TVT-O), n (%)	10 (7.1%)	1 (0.7%)	0.691

BMI body mass index, CHD coronary heart disease, Mid-urethral slings included both the retropubic (TVT-E) and transobturator (TVT-O) approaches

P values of < 0.05 were considered to be statistically significant and mentioned in bold

Mesh kits included: TiLOOP® Total 6 and TiLOOP® Total 4 (pfm medical, Germany), Avaulta® (CR Bard, USA), Herniamesh® (HERNIAMESH SRL, Italy), and DynaMesh® (FEG Textiltechnik, Germany)

At the last follow-up, all 140 patients (100%) completed telephone questionnaires, while 42 (30.0%) additionally underwent in-person examination. The available postoperative POP-Q data from the subset of patients (55.0%, n = 77) who attended any clinic visit at various timepoints are provided in Table S1. Overall, only six patients (4.3%) (95% CI, 0.9–7.7%) reported subjective prolapse recurrence at times ranging from approximately 1 to 48 months, yielding a subjective cure rate of 95.7%. Subsequent trachelectomy was performed in one case, with the others receiving no further surgical intervention. Mesh exposure occurred in six patients (4.3%) (95% CI, 0.9–7.7%). Relevant information is detailed in Table 2. All cases resolved successfully with management. Urgency urinary incontinence (UUI) was identified in ten patients (7.1%) (95% CI, 2.8–11.5%), with de novo cases occurring in six patients (4.3%) (95% CI, 0.9–7.7%). Stress urinary incontinence (SUI) was reported in 33 patients (23.6%) (95% CI, 16.5–30.7%). Among them, 22 patients (15.7%) (95% CI, 9.6–21.8%) presented as de novo SUI. PGI-C scores were 7 (6, 7), with 138 patients (98.6%) reporting overall symptom improvement compared to baseline. At follow-up, the median PFIQ-7 score was 0 (0, 14.3) and the median PFDI-20 score was 12.5 (3.4, 33.4). Significant improvements were observed in both PFIQ-7 and PFDI-20 scores following TVM surgery (both P < 0.001), as detailed in Table 3.

Table 2.

Mesh exposure-related information

	Age at surgery(years)	The exposed position of the mesh	Area of exposed mesh	Postoperative time of occurrence (months)	Stage of menstruation	History of hysterectomy	Use of estrogen postoperatively	Treatment	Clavien-Dindo grading
1	58	Right side of the top of the vagina	2 cm x 3 cm	96	Post-menopause	None	yes	Transvaginal mesh removal procedure	IIIb
2	51	Posterior vaginal wall, near the fornix	0.5 cm × 0.5 cm	72	Post-menopause	None	yes	Clipping of exposed mesh in clinic	I
3	51	Upper middle part of the anterior vaginal wall	0.5 cm × 0.5 cm	12	Post-menopause	None	yes	Clipping of exposed mesh in clinic	I
4	54	Middle of the posterior vaginal vault	1 cm x 1 cm	6	Post-menopause	None	yes	Transvaginal mesh removal procedure	IIIb
5	55	Lower part of the posterior vaginal wall & Middle of the posterior vaginal wall	0.3 cm × 0.6 cm & 0.5 cm × 0.5 cm	4 & 72	Post-menopause	None	yes	Clipping of exposed mesh in clinic	I
6	59	Posterior wall of the cervix	0.1 cm x 1 cm	10	Post-menopause	None	yes	Clipping of exposed mesh in clinic	I

Table 3.

Questionnaire comparisons between pre-operation and last follow-up

All patients (n = 143)	Preoperative characteristics	Last follow-up characteristics	Z	P value
PFIQ-7	61.0 (32.0, 80.0)	0 (0, 14.3)	−7.788	<.001
PFDI-20	64.6 (38.54 84.4)	12.5 (3.4, 33.4)	−8.103	<.001
Sexually active patients (n = 39)	Preoperative characteristics	Last follow-up characteristics	Z	P value
PISQ-12	30.0 (25.0, 35.0)	32.0 (27.0, 35.0)	−1.315	0.189

PFIQ-7 Pelvic floor impact questionnaire short form 7, PFDI-20 Pelvic floor distress inventory short form 20, PISQ-12 Pelvic organ prolapse/urinary incontinence sexual questionnaire short form 12

P values of < 0.05 were considered to be statistically significant and mentioned in bold

Wilcoxon signed rank test was used for statistical analysis

Preoperatively, 57 patients (40.7%) reported being sexually active, with a median age of 56 years (53–58). At follow-up, 43 patients (30.7%) (95% CI, 23.0–38.5%) were sexually active, comprising four patients who resumed sexual activity postoperatively and 39 patients (27.9%) with recorded sexual activity both pre- and postoperatively. The 97 patients (69.3%) who were not sexually active at follow-up reported their reasons, as detailed in Table S2. Analysis of PISQ-12 scores among the patients with complete datasets revealed no significant differences (Table 4), suggesting that TVM surgery had no substantial impact on sexual function. Of the 43 sexually active patients postoperatively, two continued vaginal estrogen therapy, 32 had discontinued therapy, and nine reported no history of estrogen use. Dyspareunia associated with vaginal dryness was reported by six patients, as illustrated in Fig. 2.

Table 4.

Questionnaires of the life quality of patients

		Pre-operation	Post-operation	Z	P value
Follow-up time < 3 years (n = 53)	PFIQ-7	56.0 (30.0, 80.0)	0 (0, 0)	−5.419	<.001
	PFDI-20	69.8 (30.7, 101.6)	15.6 (0, 35.4)	−5.006	<.001
Follow-up time ≥ 3 years (n = 87)	PFIQ-7	56.0 (42.0, 80.0)	0 (0, 23.8)	−6.360	<.001
	PFDI-20	64.6 (43.8, 84.4)	11.5 (4.2, 33.4)	−5.682	<.001

PFIQ-7 Pelvic floor impact questionnaire short form 7, PFDI-20 pelvic floor distress inventory short form 20

P values of < 0.05 were considered to be statistically significant and mentioned in bold

Wilcoxon signed rank test was used for statistical analysis

Fig. 2.

Flowchart of vaginal estrogen therapy utilization among sexually active patients at follow-up (n = 43). Postoperative vaginal estrogen status was categorized into three groups: continued therapy (n = 2), discontinued therapy (n = 32), and no history of estrogen use (n = 9). Dyspareunia with vaginal dryness was reported by six patients in total, as denoted in the terminal branch

Follow-up Time < 3 Years

The medium- to short-term follow-up had included 53 patients, with a median duration of 12 months (6, 24). In this subgroup, three patients reported a subjective sensation of prolapse, two developed dysuria, two experienced recurrent urinary tract infection (UTI) symptoms, two developed de novo UUI, and five developed de novo SUI. Two patients experienced mesh exposure, and 22 resumed normal sexual activity 6 months postoperatively. The median PISQ-12 score among these patients was 32.5 (28.5, 35.8).

Follow-up Time ≥ 3 Years

A total of 87 patients were included in the long-term follow-up subgroup, with a median duration of 67 months (56, 86). Patient satisfaction, measured using the PGI-C, had a median score of 7 (6, 7). The median postoperative PFIQ-7 and PFDI-20 scores were 0 (0, 23.8) and 11.5 (4.2, 33.4), respectively. A comparison of preoperative and postoperative scores between both groups is presented in Table 4. Among these patients, three reported a subjective sensation of prolapse, and four experienced mesh exposure. At the time of follow-up, 21 patients remained sexually active. The median PISQ-12 score among these patients was 32.0 (27.5, 33.5).

Discussion

TVM is recommended for recurrent POP or primary severe anterior POP in women over 60 years in China, while its use is cautioned in young sexually active patients due to potential mesh-related and other refractory complications. This study evaluated long-term outcomes of TVM in patients with stage III or IV prolapse who were younger than current guideline recommendations. Patient-reported outcomes served as the primary indicator of surgical success, as symptom relief, particularly the resolution of vaginal bulging, has been shown to correlate more strongly with patient satisfaction than anatomical results alone [9]. In a retrospective cohort study with 8-year median follow-up, the subjective cure rate was 91.4%, with only one case of prolapse recurrence [10]. This aligns with a 10-year meta-analysis that reported a 95.7% cure rate for TVM in pelvic organ prolapse [11]. Similarly, the results of a 1-year randomized controlled trial demonstrated a 96.2% subjective cure rate in patients treated with TVM [12]. In our study, the subjective cure rate was 95.7% (95% CI, 92.3–99.1%), which is also comparable. The results suggest that TVM is effective for treating severe prolapse in younger patients 60 years old and younger.

The FDA first warned serious complications associated with TVM in a 2008 public health notice [13]. Subsequent safety updates and associated controversies led to decreased TVM utilization in certain regions [14], culminating in a 2019 mandate for manufacturers to cease distribution due to insufficient safety evidence [13]. Current guidelines restrict TVM use to specific populations, mainly indicated in cases of severe or recurrent prolapse, emphasizing careful patient selection [15]. In our cohort, all patients had stage III or IV prolapse, which itself is a well-recognized high-risk factor for recurrence [16], with 89.3% involving multiple compartments. This severity of prolapse, combined with the need for concurrent transvaginal procedures to address concomitant symptoms, justified the use of TVM in these younger patients despite age-based guideline recommendations [8]. The reported incidence of mesh exposure varies widely among studies, ranging from 1.1% to 16.6% [10, 17–19]. In this study, the mesh exposure rate was 4.3% (95% CI, 0.9–7.7%), supporting the relative safety of TVM in this specific population. These positive outcomes in younger patients may be attributed to multiple factors, including enhanced physiological resilience, comprehensive preoperative evaluation, surgical expertise, and appropriate mesh selection. Surgical skill also critically impacts TVM outcomes: precise anatomical mesh placement ensures procedural safety and postoperative quality of life, while optimal tensioning adjustment of mesh affects long-term recurrence and complication occurrence.

Postoperative lower urinary tract symptoms (LUTS), particularly SUI and UUI, are commonly observed following POP correction. The use of mesh was not identified as an independent risk factor for either condition [20]. Comparative studies have shown higher rates of de novo SUI in TVM procedures compared to Robotic Sacrocolpopexy (RSC) (25.6% vs 5.4%) [21]. A prospective controlled study reported a 26.7% rate of de novo urodynamic stress incontinence following TVM [22]. Our study observed a postoperative de novo SUI incidence of 15.7% (95% CI, 9.6–21.8%), in agreement with the epidemiological rates described earlier. Notably, some patients may have occult urinary incontinence prior to surgery, which becomes apparent when TVM surgery restores the previously twisted or compressed urethra to its anatomical position, revealing the original SUI. Assessing preoperative occult SUI by reducing prolapse symptoms is increasingly advocated as an important strategy to reduce the risk of de novo SUI after POP repair surgery [23, 24]. Our study found a de novo UUI rate of (4.3%) (95% CI, 0.9–7.7%) after surgery, lower than previous reports [20, 25]. The symptom may be associated with overactive bladder syndrome (OAB) in patients as a result of the aging process. Among the six patients with de novo UUI in our group, four patients had mild OAB and two had moderate OAB; none had diabetes. All achieved satisfactory symptom control with oral medication.

Previous studies have demonstrated TVM safety and efficacy in sexually inactive patients, while noting increased risk of dyspareunia and vaginal dryness postoperatively [26, 27]. In contrast, a systematic review demonstrated that patients’ sexual function either improved or remained unchanged following all types of POP reconstructive surgery [28]. Analysis of PISQ-12 scores in our study revealed no significant difference before and after surgery, suggesting that TVM did not markedly impair sexual function in the cohort that remained sexually active. Of the 57 sexually active patients preoperatively, 39 maintained sexual activity at follow-up. Several factors contributed to this decline, including aging, shifts in partner status, declined libido, and the potential impact of the implanted mesh. However, analyzing only the subset of patients who remained sexually active may introduce selection bias. This approach inherently excludes those who discontinued sexual activity postoperatively, potentially omitting important negative outcomes such as dyspareunia or vaginal dryness that directly contributed to their withdrawal. In our study, the 18 patients who transitioned from being sexually active preoperatively to inactive at follow-up represent a crucial group. If their experiences are not considered, the analysis may overestimate the true safety profile of TVM regarding sexual function, as it fails to capture the very patients who might have been most adversely affected.

Vaginal estrogen therapy was prescribed postoperatively to all patients to facilitate wound healing and reduce mesh exposure risk, though adherence was voluntary. Among the 43 sexually active patients at follow-up, six (14.0%) reported dyspareunia with vaginal dryness. Regarding estrogen therapy, 32 patients (74.4%) had discontinued use, two (4.7%) continued treatment, and nine (20.9%) never initiated therapy. While local estrogen therapy has demonstrated benefits for vaginal epithelial healing [29] and can assist in maintaining vaginal elasticity and moisturization, its impact on postoperative sexual function remains unclear in current literature. The effect of estrogen on the improvement of sexual function after surgery is not obvious and highly individualized in this study. Additionally, the assessment of dyspareunia was based on patient reports rather than a specific validated questionnaire item, which is a limitation of our study. Sexual satisfaction is influenced by a complex interplay of social, cultural, and psychological factors, and estrogen use alone is not a decisive determinant. Further studies, ideally employing detailed instruments like the PISQ-IR, are warranted to evaluate the postoperative sexual function.

Overall, this study provides meaningful insights into the long-term outcomes of younger patients following TVM surgery with a median follow-up period of 5 years. All procedures were performed by experienced surgeons following standardized protocols, thereby minimizing the variability of surgical techniques as a potential confounding factor. However, several limitations should be acknowledged. First, the retrospective single-center design conducted at a high-volume center may limit the generalizability of our findings. The absence of a control group and the lack of objective POP-Q outcome data at follow-up preclude a comparative analysis and robust anatomical assessment. Although baseline characteristics showed no major differences between completers and those lost to follow-up, the attrition rate of 17.6% still poses a potential risk for attrition bias. Furthermore, data collection via telephone interviews is inherently susceptible to recall bias. Finally, the low incidence of key safety outcomes limited our ability to perform multivariable analyses to control for potential confounders such as age and mesh type. Given the current decline in TVM use among younger patients due to mesh-related concerns, future studies should compare its efficacy with non-transvaginal surgical approaches, particularly regarding quality of life and long-term effectiveness in young patients.

In conclusion, our long-term data suggest that TVM provides satisfactory clinical outcomes for women aged 60 years or younger with severe POP, with a low rate of complications and improved quality of life. Among patients who remained sexually active, sexual function was not significantly impaired. Comprehensive preoperative counseling, which should include a discussion on the potential for cessation of sexual activity, and individualized patient evaluation remain essential.

Supplementary Information

Below is the link to the electronic supplementary material.

Author Contributions

LI, S: Data collection or management, Data analysis, Manuscript writing/editing.

CHEN, Y: Data collection or management, Manuscript writing/editing.

MEI, L: Data analysis, Manuscript writing/editing.

NIU, X: Protocol development, Manuscript writing/editing.

Funding

This study was supported by the National Key Research and Development Program of China (No. 2021YFC2009100).

Data Availability

The data that support the findings of this study are not publicly available due to the sensitive nature of the clinical data containing patient information. However, the data are available from the corresponding author upon reasonable request and with the approval of the Medical Ethics Committee of West China Second University Hospital, Sichuan University.

Declarations

Ethical Approval

This study was approved by the Medical Ethics Committee of West China Second University Hospital, Sichuan University (Approval No. 2023–317).

Meeting Presentation

Presented at the IUGA Anual Meeting 2024 in Singapore, June 19–22, 2024.

Conflicts of interest

None.