International Journal of Clinical Obstetrics and Gynaecology

Background: Pelvic Organ Prolapse (POP) is a prevalent condition affecting millions of women globally, often impairing physical, sexual, and psychological well-being. Surgical intervention remains the mainstay of treatment for advanced-stage disease. However, the optimal surgical approach remains debated due to differences in recurrence rates, functional outcomes, and complication profiles.
Objective: To evaluate and compare the clinical outcomes, recurrence rates, functional improvements, and perioperative complications associated with native tissue repair and mesh-augmented procedures for the surgical management of POP.
Materials and Methods: A prospective observational study was conducted on 240 women with POP stages II-IV, allocated to either native tissue repair (N=140) or mesh-augmented surgery (N=100). Baseline characteristics, intraoperative data, and postoperative outcomes were collected. The primary outcomes included anatomic success and recurrence rates at 12 months. Secondary outcomes assessed quality of life (PFDI-20), sexual function (PISQ-12), length of hospital stay, and complications. Statistical analysis employed t-tests, Mann-Whitney U, and Chi-square tests, with p<0.05 considered significant.
Results: Anatomic success was significantly higher in the mesh group (90.0%) compared to the native tissue group (78.0%) (P=0.003). Recurrence was lower in the mesh group (10.0%) than in the native group (22.1%) (P=0.004). Both groups showed substantial improvements in PFDI-20 and PISQ-12 scores, with no significant between-group differences. Complications were more frequent with mesh procedures (22.0%) than native repairs (12.1%) (P=0.028), with mesh-specific issues including exposure, pain, and infection. Native tissue complications were fewer and mostly related to functional outcomes such as dyspareunia and de novo stress urinary incontinence.
Conclusion: Mesh-augmented POP surgery provides superior anatomic outcomes but carries a higher complication risk, whereas native tissue repair offers meaningful functional improvement with fewer device-related adverse events. Surgical decision-making should be individualized, integrating patient preferences, prolapse severity, and risk factors. Multidisciplinary care, structured follow-up, and patient education are essential to optimize long-term outcomes and quality of life.