New considerations in the use of vaginal mesh for prolapse repair

The proliferation of mesh-based transvaginal prolapse surgical repair methods and products has generated increased scrutiny of the evidence-based foundation in support of these techniques. Recent developments in this arena include the publication of the Society of Gynecologic Surgeons Systematic Review Group, which concluded that supportive evidence for transvaginal mesh is limited, and a Public Health Notification from the Food and Drug Administration (FDA), regarding "serious complications associated with transvaginal placement of surgical mesh in repair of pelvic organ prolapse and stress urinary incontinence." This article reviews available literature regarding transvaginal mesh use, specifically regarding material, technique, and patient characteristics that may influence the rates of iatrogenic complications of transvaginal mesh prolapse repairs. Compliance with the FDA Public Health Notification is encouraged, and additional clinical practice guidelines are provided.