Trends in Prolapse Repair Approaches Before and After Ban of Transvaginal Mesh

The introduction of transvaginal mesh (TVM) in 2002 for pelvic organ prolapse (POP) repair gained initial popularity until official warnings were released about its associated complications. This study compares the changes in practice patterns between Urogynecology and Reconstructive Pelvic Surgery (URPS)-trained and non-URPS-trained urologists following the warnings and eventual ban of TVM for prolapse repair.

Case logs from 2001 to 2022 were queried from the American Board of Urology. POP repair cases were identified by their Current Procedural Terminology codes and categorized by surgical approach: vaginal with TVM, vaginal without TVM, and abdominal. Urologists were identified as URPS or non-URPS trained. Case log trends were analyzed before and after the initial US Food and Drug Administration (FDA) warning in 2008 and FDA ban in 2019.

TVM was rapidly adopted for vaginal POP repair in 2005 as seen by a 9200% increase among URPS urologists and 558% increase among non-URPS urologists. After the 2008 FDA warning against TVM, URPS urologists transitioned from TVM to non-TVM techniques for POP repair sooner than non-URPS urologists. After the TVM ban in 2019, URPS urologists performed significantly more abdominal approach and vaginal approach with TVM for POP repair.

The use of TVM decreased for both URPS and non-URPS urologists in response to the FDA health warnings and eventual ban of TVM for POP. URPS urologists adapted to non-TVM techniques sooner than non-URPS urologists. By 2021, URPS urologists were performing the majority of POP repair cases compared with non-URPS urologists.