Biologic and synthetic graft use in pelvic surgery: a review

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.

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.