Assessment of current options for correction of stress urinary incontinence and pelvic organ prolapse without mesh implants

Background: Between 40% and 80% of women over the age of 50 experience pelvic organ prolapse of varying clinical severity, often accompanied by stress urinary incontinence. With a growing trend toward abandoning synthetic meshes in pelvic surgery, the search for alternative treatment methods has become a relevant issue.

Aim: To assess the potential for correcting stress urinary incontinence and pelvic organ prolapse without using mesh implants.

Methods: A prospective clinical study included 70 women with varying degrees of pelvic organ prolapse. Patients with stage I prolapse according to the POP-Q classification were included only if they had concomitant complaints of stress urinary incontinence. These patients formed Group 1 (n = 24). Group 2 included patients with stage II–IV pelvic organ prolapse by the POP-Q with mandatory apical compartment descent (n = 46). Patients from each group were divided into subgroups. Subgroup 1A received transurethral injections of fillers, whereas subgroup 1B underwent conventional TVT-O sling placement. In Group 2, two types of surgery were performed according to subgroup assignment: in subgroup 2A, laparoscopic promontofixation of the cervical stump was carried out using a mesh-less technique (native tissues and suture material); in subgroup 2B, conventional laparoscopic sacrocolpopexy with polypropylene mesh was performed.

Results: In Group 1, 12 months after filler injection, clinical efficacy was sustained in 40% of patients, which was more than two times lower than in the mesh sling group (93%). With careful patient selection, fillers may reduce hospital workload by shifting a portion of stage I pelvic organ prolapse patients with stress urinary incontinence symptoms to outpatient care, while lowering the use of foreign implants. In Group 2, the anatomical success rate at 1 month was 92% in subgroup 2A (mesh-less) versus 90% in subgroup 2B (p = 0.265). Although 1-year recurrence rates were comparable between subgroups, long-term follow-up over 5–10 years is necessary for a comprehensive outcome assessment.

Conclusion: Given the minor advantages of various mesh implants in pelvic surgery, their high cost and increasing rates of intra- and postoperative complications have led to a trend toward alternative surgical approaches using autologous tissues and non-surgical injectable therapies in cases of stress urinary incontinence.