The use of biological and synthetic materials in vaginal surgery for prolapse

This article reviews the currently available biological and synthetic graft materials available for pelvic prolapse. It also focuses on recent publications examining their use in transvaginal prolapse surgery.

There continue to be many case series investigating the treatment of anterior prolapse, however there are still very few publications examining new techniques involving apical fixation with large anterior/posterior meshes. Of note are three randomized studies that have recently been reported--two with anterior prolapse, one showing a lack of significant benefit of cadaveric fascia, one demonstrating the benefit of porcine dermis, and one with posterior prolapse demonstrating a lack of benefit of porcine SIS.

Despite the paucity of randomized control trials of various graft materials used in transvaginal prolapse surgery, the many case series published to date generally show relative safety and efficacy. There is still a need for more randomized controlled trials, however, to guide therapy and for well designed case series with longer follow up, especially regarding new techniques involving large anterior/posterior meshes.