Comparison of efficacy and safety between native tissue repair and transvaginal mesh for uterine prolapse: a retrospective study

Background The surgical treatment for patients with uterine prolapse usually adopts two methods: native tissue repair (NTR) and transvaginal mesh (TVM). However, there is still inconsistent conclusion regarding the efficacy and safety of these two methods at present. Objective The aim is to compare the efficacy and safety of native tissue repair and transvaginal mesh in the treatment of symptomatic uterine prolapse. Methods This study included 86 patients who were admitted to the hospital due to uterine prolapse from January 2022 to December 2024. According to the type of surgery they received, the patients were divided into two groups: the NTR group ( n = 37) and the TVM group ( n = 49). The perioperative indicators of the two groups were compared. The subjective symptom improvement was evaluated using the PFDI-20 score, the quality of life changes were reflected by the PFIQ-7 score, patient satisfaction was assessed using the PGI-I score, and the incidence of postoperative complications and the recurrence rate within one year were also compared. Results The average operation time of the NTR group was 177.3 ± 30.51 min, while the operation time of the TVM group was shorter, at 148.8 ± 21.12 min ( P < 0.001). In terms of hospital stay, the TVM group had a longer stay (6.49 ± 1.37 days), while the NTR group had a shorter stay (5.51 ± 1.22 days), and the difference was statistically significant ( P < 0.001). The postoperative PFDI-20 and PFIQ-7 scores of the two groups improved significantly ( P < 0.001), with the TVM group having a lower PFIQ-7 score (26.53 ± 6.37 vs. 30.84 ± 8.59, P = 0.009). The subjective satisfaction of the patients in both groups was similar, at 91.89% and 91.84% respectively, with no significant difference ( P > 0.05). The overall complication rate of the TVM group was higher (30.61% vs. 10.81%, P = 0.028), but the recurrence rate was lower (4.08% vs. 18.92%, P = 0.029). Subgroup analysis of the TVM group showed that synthetic mesh was associated with a higher complication rate (34.15%) but lower 1-year recurrence (2.44%), whereas bioabsorbable mesh had a lower complication rate (12.50%) but higher recurrence (12.50%). Conclusion Whether it is native tissue repair or vaginal mesh, both can improve the symptoms and overall health conditions of women with uterine prolapse. Vaginal mesh has a significant advantage in reducing the recurrence rate, but it also comes with a higher risk of mesh-related complications. Native tissue repair has advantages in terms of safety and complication rate, but its recurrence risk is relatively higher. Therefore, when choosing a specific surgical plan, it is necessary to comprehensively assess the individual circumstances of each patient and weigh the surgical effect against safety.