ORIGINAL ARTICLE Pelvic organ prolapse repair with a trocarless mesh system: two-year results Guner Yildiz 1 & Ozcan Kilic 2 & Ali Furkan Batur 2 & Murat Akand 2 Received: 28 March 2019 /Accepted: 24 July 2019 # The International Urogynecological Association 2019 Abstract Introduction and hypothesis Our aim was to investigate the efficacy of the EndoFast Reliant™ system, which is a novel trocarless mesh technology for the treatment of pelvic organ prolapse (POP). Methods This was a retrospective cohort study including 31 female patients with POP who underwent vaginal repair. Total follow-up duration was 24 months. All patients were evaluated with a clinical history, POP-Q measures, pelvic ultrasound, body mass index (BMI), questionnaires on symptoms, and quality of life scoring system. Results The mean age was 53 ± 9.7 years, and the mean BMI was 28.5 ± 3.9 kg/m 2 . The BMI of 20 patients was < 30 kg/m 2 . No intraoperative complications occurred. Prolapse was anatomically resolved in 87.1% of patients at 2-year follow-up. Four patients presented stage 1 non-symptomatic prolapse recurrence. De novo stress urinary incontinence developed in four (12.9%) cases and de novo urgency developed in two (6.4%) cases; all were diagnosed and treated easily with oral medication. One case of mesh exposure was found and treated conservatively. There was no migration of fasteners or mesh. Urinary retention, postoperative groin pain, and dyspareunia were not observed. Conclusions The EndoFast Reliant™ system was found successful with high success rates, short learning time and very low complication rates in our study. However, further prospective studies with higher patient numbers and longer follow-up durations are needed to reach definitive conclusions. Keywords Cystocele . Pelvic organ prolapse . Mesh . Trocarless repair . Vaginal Abbreviations POP Pelvic organ prolapse ASC Abdominal sacro-colpopexy POP-Q Pelvic Organ Prolapse-Quantification BMI Body mass index UDI-6 Urinary Distress Inventory IIQ-7 Incontinence Impact Questionnaire FSFI Female Sexual Function Index PFDI-20 Pelvic Floor Distress Inventory SUI Stress urinary incontinence Introduction Pelvic organ prolapse (POP) is a common health problem that disrupts women's quality of life. POP prevalence reaches up to 50% among all age groups [1]. Of these patients, 6% to 19% were operated on for POP, and approximately 29% of those operated were re-operated within 3–5 years. In the USA, the estimated lifetime risk of undergoing at least one POP surgery was reported to be 11.1% [2]. Several different vaginal and abdominal techniques have been depicted for the treatment of POP so far. Anterior and posterior colporrhaphy, sacrospinous and uterosacral ligament apical suspensions, and McCall culdoplasty with or without vaginal hysterectomy are some of the native tissue reconstructive repair tech- niques. However, the recurrence rates of the classical repair techniques by endopelvic fascia ligation are quite high (up to 45% during 1–3 years follow-up) [2, 3]. However, there is still controversy over the superiority and complications of the abdominal approaches over the * Guner Yildiz drgyildiz@yahoo.com.tr 1 Urology Clinic, Health Sciences University Dr.Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Izmir, Turkey 2 Department or Urology, Selçuk University, School of Medicine, Konya, Turkey International Urogynecology Journal https://doi.org/10.1007/s00192-019-04072-y