Efficacy and Safety of Transvaginal Prolene Mesh–Augmented Rectocele Repair: A Retrospective Cohort Study

Background/Objectives: Posterior vaginal wall prolapse (rectocele) significantly im-pairs bowel function and quality of life (QoL). This study evaluated the short-term functional, QoL, and safety outcomes of transvaginal Prolene mesh–augmented recto-cele repair and examined predictors of recurrence. Methods: A retrospective cohort of 120 women (mean age 49.5 ± 11.0 years) who underwent transvaginal mesh-augmented rectocele repair between January 2020 and July 2023 was analysed. Functional and QoL outcomes were assessed using the Constipation Scoring System (CSS), Obstructed Defecation Syndrome (ODS) score, Patient Assessment of Constipa-tion Quality of Life (PAC-QOL), and Visual Analogue Scale (VAS) for pelvic/rectal pain. Results All functional and QoL scores improved significantly at 12 months (all p < 0.001): CSS decreased from 9.5 ± 2.8 to 6.0 ± 3.1 (−36.8%), ODS from 22.3 ± 7.5 to 15.4 ± 5.2 (−30.9%), PAC-QOL from 58.6 ± 15.5 to 39.1 ± 18.2 (−33.3%), and VAS pain from 7.38 ± 1.73 to 4.61 ± 1.67 (−37.5%). The overall complication rate was 11.7%, with mesh exposure (5.0%), retraction (4.2%), and infection (1.7%). Multiparity (p = 0.004) and higher BMI (p = 0.011) were independently associated with recurrence. Conclusions: Transvaginal mesh–augmented rectocele repair provides substantial short-term im-provements in bowel function, pain, and QoL with an acceptable safety profile. Multi-parity and obesity are important predictors of recurrence, underscoring the need for individualized risk assessment and long-term follow-up.