Controversies in Pelvic Organ Prolapse: Mesh Interposition in Prolapse Repair

Introduction

A medical dictionary defines prolapse as “the protrusion of an organ or part of an organ into a natural or artificial orifice,”1 and when discussing pelvic organ prolapse (POP) the protrusion is into the potential space of the vagina. The organs may include the urethra, bladder, uterus, small or large intestines, the rectum, or any combination thereof. The main reason for the development of POP is a defect or weakness in the support mechanism of each of the pelvic organs and surgical correction has traditionally relied on the reapproximation of native tissue.2 These techniques have been utilized for over a century and are widely considered to be the first-line surgical options for women with POP.2

Abstract

INTRODUCTION

As the durability of standard prolapse repairs may be in question, synthetic meshes have become a popular adjunct for providing additional support. However, several questions remain unanswered regarding their implementation.

OBJECTIVES

(1) To summarize the available literature regarding the transvaginal placement of synthetic mesh for prolapse repair, with a focus on the outcomes and complications of commercial prolapse kits; (2) draw comparisons with standard prolapse repairs; and (3) address common questions regarding vaginal mesh placement.

METHODS

A MEDLINE search was performed for available English language literature relating to transvaginal synthetic mesh placement. GOOGLE translator was used for pertinent non-English language articles.

RESULTS

Short-term anatomic recurrence rates after mesh-augmented anterior repair are lower than standard repairs. Currently, there is no data to support mesh placement in the posterior compartment. Kit repairs are associated with unique complications relating to trocar passage and mesh placement (eg, extrusion and erosion). Dyspareunia may be multifactorial and may occur after standard and mesh repairs. Currently, a causal relationship between mesh placement and dyspareunia is not clear.

CONCLUSIONS

The decision to place mesh transvaginally should be tailored to each patient, as both the rates of short-term anatomic success and complications may both be higher than those associated with standard prolapse repairs. Long-term, prospective, randomized controlled trials are vital to progress our knowledge of mesh-augmented prolapse repair.

Keywords

pelvic organ prolapse, polypropylene, vaginal mesh, extrusion, erosion, dyspareunia