From Mesh to Modern Therapies: An Updated Narrative Review on Urogenital Prolapse

Urogenital prolapse (UP), a manifestation of pelvic organ prolapse (POP), is prevalent and burdensome, impairing urinary, bowel, sexual and psychosocial health. This review synthesizes evidence on epidemiology, mechanisms, clinical evaluation and treatment, with an emphasis on mesh use. POP results from failure of muscular and fascial support, most consistently associated with childbirth and aging; imaging links levator ani avulsion and hiatal overstretching to onset and recurrence. Diagnosis is chiefly clinical, using standardized pelvic examination, with selective adjuncts such as urodynamics, cystoscopy, pelvic floor ultrasound and defecography. Conservative care includes education, lifestyle measures, pelvic floor muscle training and pessaries. Surgery is considered for bothersome prolapse and individualized by compartment, symptoms, sexual goals, comorbidities and preference. Options span native-tissue vaginal repairs with apical suspension, obliterative procedures for non-sexually active patients and sacrocolpopexy. Sacrocolpopexy remains the durability benchmark for apical support but carries mesh-related risks that accumulate over time. Regulatory scrutiny followed rising complications, culminating in withdrawal of transvaginal mesh kits for anterior prolapse, while mesh for sacrocolpopexy persists. Quality-of-life outcomes are central to assessment. Pain after mesh may reflect placement or evolution (erosion, proximity) or persist despite normal findings, implicating neuroplastic mechanisms. Individualized, shared decision-making is essential to balance durability, safety and function.