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What part does mesh play in urogenital prolapse management today?

Costantini, Elisabettaa; Lazzeri, Massimob

doi: 10.1097/MOU.0000000000000177
EVIDENCE BASED UROLOGY: RELATION TO FEMALE UROLOGY: Edited by Christopher R. Chapple
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Purpose of review The present review examines the pros and cons of the controversial role of mesh in the management of pelvic organ prolapse (POP). With a view to understanding where we are going, we analyzed recent data, highlighting the most important and interesting articles that were published in the past 12 months.

Recent findings Four main themes emerged. US Food and Drug Administration warnings stimulated an ongoing debate about the role of controversial trans-vaginal mesh, with some uro-gynaecologists tending to provide evidence that trans-vaginal mesh is safe whereas others advocated less aggressive abdominal procedures because minimally invasive techniques such as laparoscopy and robot-assisted surgery seem to provide similar outcomes. Recent systematic reviews and a meta-analysis of POP surgery compared mesh and native tissues, addressing functional outcomes and complications. Finally, ongoing research into new materials might open up further opportunities in the controversial field of POP surgery with mesh.

Summary The use of mesh for reconstruction of pelvic floor anatomical defects plays a key role in POP management. Given the controversy about the pros and cons of native tissue POP repair versus mesh repair and mesh-related complications, uro-gynaecologists are moving toward alternative surgical approaches and new materials.

aDepartment of Surgical and Biomedical Science, Urology and Andrology Clinic, University of Perugia

bDepartment of Urology, Humanitas Clinical and Research Center, Humanitas University, Milano, Italy

Correspondence to Elisabetta Costantini, MD Urologist, Department of Surgical and Biomedical Science, Urology and Andrology Clinic, University of Perugia, S. M. Misericordia Hospital, S. Andrea delle Fratte, 06123 Perugia, Italy. Tel: +39 0755783743; fax: +39 0755784416; e-mail: elisabetta.costantini@unipg.it

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