A nationwide, prospective, longitudinal cohort study using the PRIMES（Chinese Pelvic Floor Reconstruction Surgery with Implants (Mesh) ）registry.

103 tertiary referral centers across China.

The primary outcome was the complication rate. Secondary outcomes included anatomical cure, symptomatic cure, composite surgical success, patient subjective satisfaction, sexual function, and quality of life. Patients were followed up for a median duration of 11.0 months, with perioperative complications observed in 3.9% (217/5621) of cases. Mesh exposure occurred in 83 instances, with an increased risk in patients who underwent a hysterectomy (HR 2.0, 95% CI 1.2-3.2, p=.004). Of these, 76 cases were less than 1cm² and 46 were asymptomatic. 7 patients (7/83, 8.4%) required subsequent surgery for partial mesh removal and mesh trimming in the operating room. TVM repair exhibited high rates of anatomical cure (91.9%, 95% CI 90.2-93.3), subjective success (93.3%, 95% CI 92.3-94.2), composite surgical success (88.5%, 95% CI 86.8-90.0), and patient satisfaction (98.2%, 95% CI 97.6-98.7) 2 years postoperatively.

TVM repairs for POP treatment result in satisfactory anatomical and subjective outcomes with relatively low mesh exposure rates, particularly among sexually inactive patients. This study underscores the importance of continuous long-term safety monitoring of mesh use and identifying risk factors. It also highlights the need for evaluating clinical decision-making in POP management.