Objective: We aimed to compare self-rated health after MUS insertion by retropubic versus transobturator approach, and to compare self-rated health in our sample with women in the French population. Design: Prospective cohort study using a register. Setting: 27 French surgical centres. Population: 1789 women participating in the VIGI-MESH register who had MUS surgery for female stress urinary incontinence. Methods: A multivariate analysis including an inverse probability of treatment weighting approach was used to emulate a trial. Self-rated health in our sample was compared to surveys in the French population. Main Outcome Measures: Women’s self-perception of health, impression of improvement, and quality of life outcomes were assessed by questionnaires. Results: A total of 1230 participants received a retropubic sling and 559 received a transobturator sling placed by 139 surgeons in 27 French centres. 34 months later, 79.6% of participants reported “good” or “very good” health (13.8% more than expected for the general population of the same age), and 78.6% felt much better. The mean quality of life scale was 76.0/100, 4.1 points higher than expected for the general population of the same age. We found no difference in the self-rated health outcomes between the two groups: retropubic and transobturator. Conclusion: Women participating to the VIGI-MESH register were in good health 3 years after MUS insertion, better than what was expected for the general French population. Regarding self-rated health, there was no difference between the two approaches: retropubic and transobturator

Objective: To assess the incidence of serious complications and reoperations for recurrence after pelvic organ prolapse (POP) surgery and compare the three most common types of repair. Design: Prospective cohort study using a registry. Setting: 19 surgical centres in France. Population: 2309 women participated between 2017 and 2019. Methods: a multivariate analysis including an inverse probability of treatment weighting approach was used to obtain three comparable groups. Main outcome measures: Serious complications and subsequent reoperations for POP recurrence Results: Mean follow-up was 16.6 months. Surgeries included in the analysis were native tissue vaginal repair (N=504), transvaginal mesh placement (692), and laparoscopic sacropexy with mesh (1113). Serious complications occurred among 52 women (2.3%), and reoperation for recurrence was required for 32 (1.4%). At one year, the cumulative weighted incidence of serious complications was 1.8% for native tissue vaginal repair (95% confidence interval 0-3.9), 3.9% for transvaginal mesh (2.0-5.9), and 2.2% for sacropexy (1.1-2.6). Compared with the native tissue vaginal repair group, the risk of serious complications was higher in the transvaginal mesh group (weighted-HR 3.84, 2.43-6.08), and the sacropexy group (2.48, 1.45-4.23), while the risk of reoperation for prolapse recurrence was reduced in both groups (transvaginal mesh [0.22, 0.13-0.39] and sacropexy [0.29, 0.18-0.47]). Conclusions: Laparoscopic sacropexy with mesh appears to have a better risk profile (few serious complications and few reoperations for recurrence) than transvaginal mesh placement (more serious complications) and native tissue vaginal repair (more reoperations for recurrence). These results are useful for informing women and for shared decision making.