Graft and mesh use in vaginal surgery

Area of Science:

• Urogynecology
• Pelvic reconstructive surgery

Background:

• Pelvic organ prolapse (POP) and urinary incontinence (UI) are prevalent chronic conditions in women.
• Increasing life expectancy leads to a higher incidence of POP and UI, necessitating surgical interventions.
• Current surgical success rates are limited, with high reoperation rates for both prolapse and incontinence.

Purpose of the Study:

• To review the role of synthetic and biological grafts and meshes in vaginal surgery for POP and UI.
• To evaluate the safety and efficacy of mesh prostheses in improving surgical outcomes and preserving function.

Main Methods:

• A literature search was conducted for English-language articles from 1997 to 2016.
• Databases searched included MEDLINE, PubMed, and the United States' National Library of Medicine.
• Approximately 50 papers were reviewed, with 30 referenced for this analysis.

Main Results:

• Polypropylene mesh demonstrates safety in vaginal surgery when utilized by experienced surgeons.
• Mesh safety is compromised when used in commercial surgical kits, particularly by less experienced providers.
• Evidence-based trials are recommended for new mesh kits before widespread adoption.

Conclusions:

• Mesh prostheses can be safe and effective tools in vaginal surgery for pelvic organ prolapse and urinary incontinence.
• Surgeon experience is a critical factor in mesh safety and surgical outcomes.
• Standardized trials and regulatory oversight are essential for the safe use of new mesh technologies.