膀胱脫垂顧名思義就是膀胱掉下來了的意思，在中年以上的女性並不少見，是一種常見的女性骨盆脫垂。它起因於陰道與膀胱之間的支持組織因為退化或過度伸展(如自然產、便祕…等)而減弱，導致膀胱從陰道前壁膨出、掉下來。輕微的脫垂患者可能症狀不明顯，較嚴重者則可能有骨盆下墜感、小便解不乾淨、性交疼痛甚至明顯感覺到陰道有膨出物的情形。

嚴重的膀胱脫垂可能需要手術矯正治療，常見的手術有三種：1. 傳統陰道前壁修補 2. 經陰道網膜手術3.腹腔鏡薦骨陰道固定手術。傳統陰道前壁修補由於手術後復發率較高，故單純只做傳統的個案有慢慢減少的趨勢。後兩者則因為手術效果好、成功率高，在近20年來蓬勃發展。到底 經陰道網膜手術與腹腔鏡薦骨陰道固定手術熟優熟劣，本文從安全的角度來作探討。

本文發表於著名的歐洲泌尿科醫學會雜誌，以證據力頗高的隨機對照試驗方式於法國11家大型醫院對257位45歲至75歲患有膀胱脫垂的女性比較接受經陰道網膜手術或者腹腔鏡薦骨陰道固定手術術後一年內發生併發症、性功能障礙、生活品質的差異。結果發現腹腔鏡薦骨陰道固定手術術後輕微和嚴重併發症的比例較低(17% vs 26%)，特別是嚴重的併發症( Clavien-Dindo classification≧3)較少發生(0.8% vs 9.4%)有達統計學上顯著的差異。而腹腔鏡薦骨陰道固定手術術後發生性交疼痛的比例也明顯較少(14% vs 30%)。

經陰道網膜手術與腹腔鏡薦骨陰道固定手術皆是膀胱脫垂矯正治療主流的手術，兩者都俱有效果好、成功率高的優點。而在安全度與性功能保存上，腹腔鏡薦骨陰道固定手術在本文中則稍勝一籌，但由於它施行的技術要求較高、手術時間也較長，手術的選擇還是須經由醫師專業的評估及與病患適當的討論來做最好的決定。

Background: Laparoscopic mesh sacropexy (LS) or transvaginal mesh repair (TVM) are surgical techniques used to treat cystoceles. Health authorities have highlighted the need for comparative studies to evaluate the safety of surgeries with meshes.

Objective: To compare the rate of complications, and functional and anatomical outcomes between LS and TVM.

Design, setting, and participants: Multicenter randomized controlled trial from October 2012 to April 2014 in 11 French public hospitals. Women with cystocele stage 2 (pelvic organ prolapse quantification), aged 45–75 yr, without previous prolapse surgery.

Intervention: Synthetic nonabsorbable mesh placed in the vesicovaginal space, sutured to the promontory (LS) or maintained by arms through pelvic ligaments (TVM).

Outcome measurements and statistical analysis: Rate of surgical complications grade II according to the modified Clavien–Dindo classification at 1 yr. Secondary outcomes were reintervention rate, and functional and anatomical results.

Results and limitations: A total of 130 women were randomized in LS and 132 in TVM; five women withdrew before intervention, leaving 129 in LS and 128 in TVM. The rate of complications grade II was lower after LS than after TVM, but did not meet statisticalsignificance (17% vs 26%, treatment difference 8.6% [95% confidence interval, CI 1.5 to 18];p = 0.088). The rate of complications of grade III or higher was nonetheless significantly lower after LS (LS = 0.8%, TVM = 9.4%, treatment difference 8.6% [95% CI 3.4%; 15%]; p = 0.001). LS was converted to TVM in 6.3%. The total reoperation rate was lower after LS but did not meet statistical significance (LS = 4.7%, TVM = 10.9%, treatment difference 6.3% [95% CI 0.4 to 13.3]; p = 0.060). There was no difference in symptoms, quality of life, improvement, composite definition of success, anatomical results rates between groups except for the vaginal apex and length, and dyspareunia (in favor of LS).