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Biologic and Synthetic Graft Use in Pelvic Surgery: A Review

Jakus, Sharon M. MD, MPH*; Shapiro, Alex MD†; Hall, Cynthia D. MD‡

Obstetrical & Gynecological Survey: April 2008 - Volume 63 - Issue 4 - pp 253-266
doi: 10.1097/OGX.0b013e318166fb44
CME Program: CATEGORY 1 CME REVIEW ARTICLES 10, 11, AND 12: CME REVIEW ARTICLE 11

Urinary incontinence and pelvic organ prolapse are some of the most commonly treated conditions in postmenopausal women. Surgical cure rates vary greatly depending on surgical technique and the type of materials used, if any, to supplement the native tissue. Traditional colporrhaphy relies on adequate tissue for a successful repair. The main concern associated with traditional plication or needle suspension type repairs is that the use of intrinsic attenuated tissue may provide a weak, constricted, or an anatomically incorrect result. Graft use allows for a broader base of support and eliminates the need to rely on the existing weakened fascia and musculature. A review of the existing literature on success rates and complications with various synthetic and biologic graft materials yielded the following conclusions. The superiority of graft use over traditional suture suspensions for abdominal sacrocolpopexy and suburethral sling procedures has clearly been shown in the literature. Macroporous monofilament synthetic grafts and non-cross-linked biologic grafts appear to have the best integration into native tissues. Solvent dehydration and irradiation of biologic grafts may weaken the integrity of the material and may prevent proper tissue integration. Technical factors related to surgical technique may impact success rates, such as tension on suture line or failure to use vaginal packing. The perfect graft material has not yet been created. Suggestions for further research include more prospective, randomized trials comparing synthetic and biologic grafts, tension-free versus secured mesh, and absorbable versus nonabsorbable mesh.

Target Audience: Obstetricians & Gynecologists, Family Physicians

Learning Objectives: After completion of this article, the reader should be able to recall how common urinary incontinence is, explain the historical considerations for diagnosis and treatment, and summarize the updated methods of treatment based upon anatomical structures and pathophysiology.

*Fellow, Urogynecology and Pelvic Reconstructive Surgery, Cedars-Sinai Medical Center, Los Angeles, California; †Fellow, Urogynecology and Pelvic Reconstructive Surgery, Women’s Hospital Memorial Medical Center, Long Beach, California; and ‡Director, Division of Urogynecology and Pelvic Reconstructive Surgery, Co-Director, Center for Women’s Continence and Pelvic Health, Cedars-Sinai Medical Center and Assistant Professor, David Geffen School of Medicine at UCLA, Los Angeles, California

Chief Editor’s Note: This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA/PRA Category 1 Credits™ can be earned in 2008. Instructions for how CME credits can be earned appear on the last page of the Table of Contents.

The authors have disclosed that they have no financial relationships with or interests in any commercial companies pertaining to this educational activity.

The Faculty and Staff in a position to control the content of this CME activity have disclosed that they have no financial relationships with, or financial interests in, any commercial companies pertaining to this educational activity.

Lippincott CME Institute, Inc. has identified and resolved all faculty and staff conflicts of interest regarding this educational activity.

Reprint requests to: Cynthia D. Hall, MD, Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 160W, Los Angeles, CA 90048. E-mail: hallc@cshs.org.

© 2008 Lippincott Williams & Wilkins, Inc.