Controversies in utilization of transvaginal mesh

Due to technological advancements, transvaginal mesh use for prolapse and incontinence has exploded over the last decade with mixed results. Recent governmental guidelines have further increased the controversy regarding the risks and benefits of mesh use forcing clinicians to critically review the available data regarding transvaginal mesh use.

With the success of the transvaginal tape procedure introduced in 1995 and re-popularization of the abdominal sacrocolpopexy using synthetic mesh, pelvic surgeons began to feel more comfortable using mesh in urogynecologic procedures and increasingly adopted the use of transvaginal mesh for repair of pelvic prolapse with the hopes of creating better long-term results with minimal complications. With introduction of commercially available kits and widespread adoption of these procedures amongst pelvic surgeons and general gynecologists, there is increasing concern regarding related complications including mesh exposure, dyspareunia/pelvic pain, infection, and organ injury. This has resulted in recent reappraisal of vaginal mesh use, increased medicolegal risk, and withdrawal of selected products.

The data regarding transvaginal mesh use are controversial and incomplete. Its use is still in its infancy in terms of material development and clinical/scientific study, and clinicians should be careful and judicious in its use.