Transvaginal mesh for prolapse repair: what is all the controversy about?

The use of synthetic mesh for the management of pelvic organ prolapse has been embroiled in a contentious debate over the past decade, with only more partisanship among physicians strictly against its use versus those pelvic surgeons who believe it to be a useful tool in their armamentarium. At the heart of the controversy lies the concern, by its detractors, for complications related to mesh use outweighing the as yet not rigorously tested benefit of augmenting repairs with mesh. This article discusses, in detail, the current literature supporting the use of mesh in the management of pelvic organ prolapse repair. The rising concern for complications, both simple and complex, will be addressed. This review aims to narrow the divide between physicians and to address their discordant beliefs by objectively reporting the most up-to-date data on biologic and synthetic mesh use in pelvic organ prolapse repair.