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Introduction and hypothesis: The aim of this study was to compare the results of repair of isolated, recurrent, posterior vaginal wall prolapse using standard posterior colporrhaphy versus non-absorbable polypropylene mesh in a routine health care setting. Methods: This cohort study was based on prospectively collected data from the Swedish National Register for Gynaecological Surgery. All patients operated for recurrent, posterior vaginal wall prolapse in Sweden between 1 January 2006 and 30 October 2016 were included. A total of 433 women underwent posterior colporrhaphy, and 193 were operated using non-absorbable mesh. Data up to 1 year were collected. Results: The 1-year patient-reported cure rate was higher for the mesh group compared with the colporrhaphy group, with an odds ratio (OR) of 2.06 [95% confidence interval (CI) 1.03–4.35], corresponding to a number needed to treat of 9.7. Patient satisfaction (OR = 2.38; CI 1.2–4.97) and improvement (OR = 2.13; CI 1.02–3.82) were higher in the mesh group. However, minor surgeon-reported complications were more frequent with mesh (OR = 2.74; CI 1.51–5.01). Patient-reported complications and re-operations within 12 months were comparable in the two groups. Conclusions: For patients with isolated rectocele relapse, mesh reinforcement enhances the likelihood of success compared with colporrhaphy at 1-year follow-up. Also, in our study, mesh repair was associated with greater patient satisfaction and improvement of symptoms, but an increase in minor complications. Our study indicates that the benefits of mesh reinforcement may outweigh the risks of this procedure for women with isolated recurrent posterior prolapse. [ABSTRACT FROM AUTHOR]

Introduction: To reduce the risk of avoidable damage to the patient when training surgeons, one must predefine what standards to achieve, as well as supervise and monitor trainees' performance. The aim of this study is to establish a quality reference, to devise comprehensive tension‐free vaginal tape (TVT) learning curves and to compare trainees' results to our quality reference. Material and methods: Using the Swedish National Quality Register for Gynecologic Surgery, we devised TVT learning curves for all Swedish TVT trainees from 2009 to 2017, covering their first 50 operations. These outcomes were compared with the results of Sweden's most experienced TVT surgeons for 14 quality variables. Results: In all, 163 trainees performed 2804 operations and 40 experienced surgeons performed 3482 operations. For our primary outcomes – perioperative bladder perforations and urinary continence after 1 year – as well as re‐admission, re‐operation and days to all daily living activities, there was no statistically significant difference between trainees and experienced surgeons at any time. For the first 10 trainee operations only, there were small differences in favor of the experienced surgeons: patient‐reported minor complications after discharge (14% vs 18.4%, P =.002), 1‐year patient‐reported improvement (95.9% vs 91.8%, P <.000), and patient satisfaction (90.9% vs 86.2%, P =.002). For both trainee operations 1‐10 and 11‐50, compared with experienced surgeons, operation time (33.8 vs 22.2 min, P <.000; 28.3 vs 22.2 min, P <.000) and hospital stay time (0.16 vs 0.06 days, P <.001; 0.1 vs 0.06 days, P <.001) were longer, perioperative blood loss was higher (27.7 vs 24.4 mL, P =.001; 26.5 vs 24.4 mL, P =.004), and patient‐reported catheterization within 8 weeks was higher (3.9% vs 1.8%, P <.000; 2.5% vs 1.8%, P =.001). One‐year voiding difficulties for trainee patients (operations 1‐10:14.2%, P =.260; operations 11‐50:14.5%, P =.126) were comparable to the experienced surgeons (12.4%). Conclusions: There is a learning curve for several secondary outcomes but the small effect size makes it improbable that the difference has clinical significance. Our national Swedish results show that it is possible to train new TVT surgeons without exposing patients to noteworthy extra risk and achieve results which are equivalent to the most experienced Swedish surgeons. [ABSTRACT FROM AUTHOR]