Platelet-Rich Plasma and Fractional CO2 Laser Therapy to Reduce Surgical Intervention for Symptomatic Vaginal Mesh-Related Complications.

Introduction and hypothesis: Mesh implants were used in Australia until 2018 for managing pelvic organ prolapse. Owing to complications such as dyspareunia, mesh exposure, erosion and vaginal discharge, transvaginal mesh was removed from the market. Regenerative treatments such as transvaginal platelet-rich plasma (PRP) and fractional CO2 laser therapy may offer relief from mesh complications.

Methods: From 2013 to 2024, women with mesh complications, including dyspareunia, vaginal discharge and/or vaginal mesh exposure (< 2 cm) awaiting surgery, were enrolled in this prospective study. Wilcoxon signed-rank test was used to assess IQR changes in Australian Pelvic Floor Questionnaire (APFQ) and Pelvic Organ Prolapse Quantification symptom severity, whereas a general linear model analysed outcome differences at baseline, 3-6 months and > 9 months. The primary aim was to assess the proportion of patients who avoided surgical intervention after PRP and CO2 laser treatment.

Results: A cohort of 47 women were eligible. The average age and body mass index were 64 years and 27.94 kg/m2 respectively. Thirty-nine received PRP and CO2 laser combined, whereas 8 underwent CO2 laser alone. Overall, 40 women (85.0%) avoided surgery over an average 12-month follow-up. APFQ scores improved significantly from baseline to > 9 months (p = 0.02). Treatments also improved bladder, bowel, prolapse and sexual function (p < 0.001) between 3-9 months. Vaginal laxity and prolapse sensation improved at 9 months (p = 0.04, p = 0.005).

Conclusions: Platelet-rich plasma and CO2 laser treatments allowed most women to avoid surgery, improving bladder, bowel, sexual function and vaginal atrophy. These alternatives may expand treatment options for mesh complications.

Keywords: CO2 laser; Pelvic organ prolapse; Platelet-rich plasma; Vaginal mesh; Vaginal mesh complications; Vaginal mesh exposure.