Human Acellular Dermal Matrix Versus Polypropylene Mesh in Pelvic Floor Reconstruction: A Retrospective Study on Surgical and Sexual Outcomes.

OBJECTIVES

To compare surgical outcomes and sexual quality of life following pelvic floor reconstruction using human acellular dermal matrix (ADM) versus polypropylene mesh (PM).

METHODS

This retrospective study included patients with anterior compartment and uterine prolapse who underwent transvaginal anterior sacrospinous ligament fixation between September 2021 and July 2023. Patients were grouped by graft type: ADM (n = 16) or PM (n = 25). Primary outcomes included operative data, complications, Pelvic Organ Prolapse Quantification scores, and quality-of-life questionnaires (Pelvic Floor Distress Inventory-20, Pelvic Floor Impact Questionnaire-7, and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12) at 3 and 12 months postoperatively.

RESULTS

Both groups showed significant postoperative improvements in Pelvic Organ Prolapse Quantification parameters and functional scores compared to baseline (P < 0.05). No significant differences were found between groups regarding blood loss, complication rates, or recurrence. The ADM group required significantly longer operative time than the PM group (88.06 vs. 61.68 minutes, P < 0.001). Postoperative dyspareunia was lower in the ADM group (7.7%) compared to the PM group (20%), though this difference was not statistically significant.

CONCLUSIONS

Both ADM and PM provide comparable anatomical success and improved patient well-being in pelvic floor reconstruction. ADM may offer advantages in preserving sexual function by reducing dyspareunia, although larger multicenter studies are needed to confirm these findings.