***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Introduction and hypothesisMany clinicians use perioperative vaginal estrogen therapy ( estradiol , E2 ) to diminish the risk of mesh erosion after prolapse surgery , though supporting evidence is limited . We assessed the feasibility of a factorial r and omized trial comparing mesh erosion rates  after vaginal mesh prolapse surgery ( VM ) versus minimally invasive sacral colpopexy ( MISC )  , with or without adjunct vaginal estrogen therapy . Methods A Markov state transition model simulated the probability of 2-year outcomes of visceral injury , mesh erosion , and reoperation after four possible prolapse therapies : VM or MISC , each with or without estrogen therapy ( E2 ) . We used pooled estimates from a systematic review to generate probability distributions for the following outcomes after each procedure : visceral injury , postoperative mesh erosion , and reoperation for either recurrent prolapse or mesh erosion . Assuming different assumptions for E2 efficacies ( 50 and 75 % reduction in erosion rates ) , Monte Carlo simulations estimated outcomes rates , which were then used to generate sample size estimates for a four-arm factorial trial . Results While E2 reduced the risk of mesh erosion for both VM and MISC , absolute reduction was small . Assuming 75 % efficacy , E2 decreased the risk of mesh erosion for VM from 7.8 to 2.0 % and for MISC from 2.0 to 0.5 % . Total sample sizes ranged from 448 to 1,620 , depending on power and E2 efficacy . Conclusions The required sample size for a trial to determine which therapy results in the lowest erosion rates would be prohibitively large . Because this remains an important clinical issue , further study design strategies could include composite outcomes , cost-effectiveness , or value of information analysis Introduction and hypothesisThe objective of the study was to compare extrusion ( vaginal mesh exposure ) rates in patients undergoing transvaginal prolapse repair with the trocar-based Apogee and /or Perigee devices ( American Medical Systems , Minnetonka , MN , USA ) using either the original type I polypropylene mesh ( IntePro , American Medical Systems , Minnetonka , MN , USA ) or a newer generation lightweight type I mesh ( IntePro Lite , American Medical Systems , Minnetonka , MN , USA ) . Methods Data were pooled from three similarly design ed prospect i ve multicenter studies evaluating the safety and efficacy of Perigee for correction of the anterior ( AC ) and /or Apogee to repair the posterior/apical ( PC/A ) compartments . The first two studies utilized IntePro ( mesh density 50 g/m2 ) and the third utilized IntePro Lite ( mesh density 25.2 g/m2 ) . Data were pooled to form IntePro and IntePro Lite groups for comparison . Patient demographics were recorded . Risk factors for vaginal mesh exposure were also considered . Results Two hundred and sixty-three patients were implanted with  Perigee and /or Apogee with IntePro for a total of 371 heavier mesh implants ( 174 Perigee , 197 Apogee ) compared to 86 patients who underwent Perigee and /or Apogee with IntePro Lite for a total of 116 lightweight mesh implants ( 60 Perigee , 56 Apogee ) . Demographics and potential risk factors for extrusion were compared between the two groups . Mean follow-up was 2.0 years and similar between the two groups . In the AC , there were 234 implants , with mesh extrusion occurring in 8.0 % following IntePro compared to 5.0 % following IntePro Lite ( p = 0.57 ) . In the PA/C , there were 253 implants , with mesh extrusion occurring in 13.7 % following IntePro compared to 7.1 % following IntePro Lite ( p = 0.25 ) . Overall mesh extrusion rates in 487 implants in all compartments were found to be 11.1 % with IntePro versus 6.0 % with IntePro Lite with an estimated odds ratio of 1.93 ( 95 % confidence interval 0.84–4.44 , p = 0.12 ) . Conclusions No statistically significant difference in extrusion rates were seen following use of IntePro versus IntePro Lite ; however , the 46 % reduction in rate of mesh exposure observed in those receiving the lighter weight mesh may represent clinical importance The goal of this study was to analyze the risk factors associated with  vaginal erosion after synthetic sling procedure for stress urinary incontinence . Follow-up evaluations were at 1 week , 1 to 3 months , 6 months , and annually after the operation . The evaluations included detailed history taking , vaginal examinations , and perineal ultrasonographic urethrocystography . The vaginal erosion rate  ( 6/239 ) after the synthetic sling procedure was 2.5 % . We assessed the relationship between clinical features and vaginal erosion . Of these , only diabetes mellitus ( DM ) was a significant risk factor for vaginal erosion .  Women with DM were 8.3 times more at risk than women without DM for developing vaginal erosion after synthetic sling procedure ( p < 0.05 ) . The vaginal erosion-free rate during the 24-month follow-up decreased significantly in women with DM . The rate of vaginal erosion associated with type III multifilamentous polypropylene sling ( intravaginal slingplasty ) is 10.7 % more than that with type I monofilament polypropylene sling ( such as tension-free vaginal tape and inside out transobturator vaginal tape ) ( p = 0.054 ) . Women with DM should be informed that vaginal erosion is a possible complication after synthetic sling procedure Objective : To compare the objective anatomic outcomes after  sacral colpopexy  performed with cadaveric fascia lata and polypropylene mesh . Methods : Patients undergoing a sacral colpopexy were r and omized to receive either fascia lata or polypropylene mesh in a double-blinded fashion . Data were collected at 6 weeks , 3 months , 6 months , and 1 year postoperatively . The main outcome measures were pelvic organ prolapse quantification ( POP-Q ) system stage and individual POP-Q points over time . Objective anatomic failure was defined as POP-Q stage 2 or more at any point during the follow-up period . Proportions of patients with objective anatomic failure at 1 year in each group were compared using the & khgr;2 test . Mean POP-Q points and stage at 1 year were compared by using the independent sample s t test . Results : One hundred patients were r and omized to receive either fascia ( n = 46 ) or mesh ( n = 54 ) . Of the 89 patients returning for 1-year follow-up , 91 % ( 41/45 ) of the mesh group and 68 % ( 30/44 ) of the fascia group were classified as objective ly cured ( P = .007 ) . We found significant differences between the mesh and fascia groups with respect to the 1-year postoperative comparisons of points Aa , C , and POP-Q stage . There were no differences between the 2 groups with respect to points TVL ( total vaginal length ) , GH ( genital hiatus ) , PB ( perineal body ) , Ap or Bp ( 2 points along the posterior vaginal wall ) . Conclusions : Polypropylene mesh was superior to fascia lata in terms of POP-Q points , POP-Q stage , and objective anatomic failure rates . Level of Evidence : OBJECTIVE : To compare efficacy and safety of trocar-guided tension-free vaginal mesh insertion with conventional vaginal prolapse repair in patients with recurrent pelvic organ prolapse . METHODS : Patients with recurrent pelvic organ prolapse stage II or higher were r and omly assigned to either conventional vaginal prolapse surgery or polypropylene mesh insertion . Primary outcome was anatomic failure ( pelvic organ prolapse stage II or higher ) in the treated vaginal compartments . Secondary outcomes were subjective improvement , effects on bother , quality of life , and adverse events . Question naires such as the Incontinence Impact Question naire and Urogenital Distress Inventory were administered at baseline , 6 months , and 12 months . Anatomic outcomes were assessed by an unblinded surgeon . Power calculation with & agr;=0.05 and & bgr;=0.80 indicated that 194 patients were needed . RESULTS : Ninety-seven women underwent conventional repair and 93 mesh repair .  The follow-up rate after 12 months was 186 of 190 patients ( 98 % ) . Twelve months postsurgery , anatomic failure in the treated compartment was observed in 38 of 84 patients ( 45.2 % ) in the conventional group and in eight of 83 patients ( 9.6 % ) in the mesh group ( P<.001 ; odds ratio , 7.7 ; 95 % confidence interval , 3.3–18 ) . Patients in either group reported less bulge and overactive bladder symptoms . Subjective improvement was reported by 64 of 80 patients ( 80 % ) in the conventional group compared with 63 of 78 patients ( 81 % ) in the mesh group . Mesh exposure was detected in 14 of 83 patients ( 16.9 % ) . CONCLUSION : At 12 months , the number of anatomic failures observed after tension-free vaginal mesh insertion was less than after conventional vaginal prolapse repair . Symptom decrease and improvement of quality of life were equal in both groups . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00372190 . LEVEL OF EVIDENCE : Introduction and hypothesisThis study is about evaluating safety and potential risk factors for complications following pelvic organ prolapse repair with the GYNECARE PROLIFT system . Methods This is a prospect i ve observational study ( Canadian Task Force II-1 ) performed in a tertiary referral center . A total of 114 women with pelvic organ prolapse , POP-Q stage ≥2 , underwent a pelvic floor repair that included Prolift .  Results During a mean follow-up time of 7 months there were six procedure failures ( 5.3 % ) and 14 mesh exposures ( 12.3 % ) , more commonly on the anterior vaginal wall . Age was inversely related to the risk of having late mesh exposure ( p = 0.02 ) with an odds ratio of 1.99 ( 95 % confidence interval 1.10–3.59 ) for each decrease of 10 years in age . Late mesh exposure was significantly more common in sexually active patients ( p = 0.016 ) . Conclusions Prolift repair has a high anatomical success rate . Young age and sexual activity are risk factors for mesh exposure OBJECTIVE : To identify possible risk factors for exposure , dyspareunia , and pain after insertion of  tension-free vaginal mesh  in pelvic organ prolapse surgery . METHODS : This was a prospect i ve observational cohort study . Consecutive women who underwent surgery with a trocar-guided tension-free vaginal mesh kit  were included and evaluated at 6 weeks and at 6 and 12 months after surgery with respect to anatomy and complications . Logistic regression analysis was performed to identify risk factors for exposure , dyspareunia , and pain . RESULTS : Two hundred ninety-four patients were included . Exposure was found in 34 patients ( 12 % ) . Smoking and total mesh were risk factors for exposure ( odds ratio [ OR ] 3.1 , 95 % confidence interval [ CI ] 1.1–8.7 and OR 3.0 , 95 % CI 1.2–7.0 , respectively ) . Clinical and surgical experience were inversely related to the risk of exposure ( OR 0.5 , 95 % CI 0.3–0.8 per decade ) . Pain ( OR 3.2 , 95 % CI 1.2–8.4 ) and dyspareunia ( OR 4.7 , 95 % CI 1.7–12.8 ) before surgery were predictive for pain and dyspareunia after surgery , respectively . Pain after surgery was found in 35 out of 275 ( 13 % ) patients and dyspareunia was found in 77 out of 171 ( 45 % ) patients . CONCLUSION : Smoking , total tension-free vaginal mesh , and experience were predictive factors for mesh exposure . LEVEL OF EVIDENCE : BACKGROUND We design ed this trial to assess whether the addition of st and ardized Burch colposuspension to abdominal sacrocolpopexy for the treatment of pelvic-organ prolapse decreases postoperative stress urinary incontinence in women without preoperative symptoms of stress incontinence . METHODS Women who did not report symptoms of stress incontinence and who chose to undergo sacrocolpopexy to treat prolapse were r and omly assigned to concomitant Burch colposuspension or to no Burch colposuspension ( control ) and were evaluated in a blinded fashion three months after the surgery . The primary outcomes included measures of stress incontinence ( symptoms , stress testing , or treatment ) and measures of urge symptoms . Enrollment was stopped after the first interim analysis because of a significantly lower frequency of stress incontinence in the group that underwent the Burch colposuspension . RESULTS Of 322 women who underwent r and omization , 157 were assigned to Burch colposuspension  and 165 to the control group . Three months after surgery , 33.6 percent of the women in the Burch group and 57.4 percent of the controls met one or more of the criteria 
    Output:
    
Our study indicates that younger age , more parities , premenopausal/ERT , diabetes mellitus , smoking , concomitant hysterectomy , and surgery performed by a junior surgeon were significant risk factors for mesh erosion after female pelvic floor reconstructive surgery .
Moreover , concomitant POP surgery and preservation of the uterus may be the potential protective factors for mesh erosion