The purpose of this review is to summarize recently published comparative trials on synthetic vaginal mesh versus traditional native tissue repairs for pelvic organ prolapse.
Although studies suggest benefit from the use of synthetic vaginal mesh for anterior compartment prolapse, data are limited on the use of mesh for posterior and apical prolapse when compared with native tissue repair. The benefits of a more durable repair must be weighed against risks such as the development of de-novo stress incontinence, visceral injury, dyspareunia, pelvic pain and mesh contraction, exposure and extrusion requiring reoperation. Furthermore, the success rates of native tissue repairs are higher than previously considered using updated validated composite outcomes that incorporate both subjective relief of bulge and objective cure defined as prolapse above the hymenal ring.
Surgeons placing synthetic mesh for pelvic organ prolapse should counsel patients regarding the potential benefits, risks, and alternatives including native tissue repairs. Level 1 evidence suggests anterior synthetic mesh may be superior to anterior repair. Expert opinion suggests potential benefit of vaginal mesh for recurrences, hysteropexy, and advanced prolapse in patients with medical co-morbidities precluding invasive open and endoscopic sacrocolpopexies; however, comparative clinical trials with long-term data are needed.
Section of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics and Gynecology and Urology, Georgetown University School of Medicine/Washington Hospital Center, Washington, District of Columbia, USA
Correspondence to Cheryl Iglesia, MD, FACOG, Director, Section of Female Pelvic Medicine and Reconstructive Surgery, Washington Hospital Center, 106 Irving Street, NW Suite 405South, Washington, DC 20010, USATel: +1 202 877 6526; fax: +1 202 877 0530