Abstract
Polypropylene (PP) mesh has been used as a primary or adjuvant material for vaginal reconstruction for both stress urinary incontinence (SUI) and pelvic organ prolapse (POP) for decades. Whether polypropylene is the optimal material for such indications has been called into question by clinicians, regulatory agencies and the public in several countries around the world. This paper is a report of presentations and subsequent discussion at the annual International Consultation on Incontinence Research Society (ICI-RS) Meeting in June 2019 in Bristol, UK on the proposal "Is polypropylene mesh material fundamentally safe for use as a reconstructive material in vaginal surgery?" in which several of the salient issues were presented and discussed.
Highlights
Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) are highly prevalent and bothersome conditions affecting a large number of individuals across the globe
Following the description of the Integral Theory[1] and the treatment of SUI using the mid‐urethral sling composed of type I polypropylene mesh, this material gained rapid acceptance and widespread utilization and with eventual expansion as a material for the repair of POP and SUI in the form of various commercially available kits
They found that tapes positioned at 50% of total urethral length sonographically measured from the bladder neck were more likely to be cured without complications than those with the tape positioned outside this range (P < .001).[40]
Summary
Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) are highly prevalent and bothersome conditions affecting a large number of individuals across the globe. The exact reasons for the increased reports of complications with the use of mesh in SUI and POP as compared to native tissue or other historical operations are unclear and very controversial Such effects could be possibly related to the material itself,[7] its effects in the human body or locally in the vagina,[8,9] a systemic reaction to mesh implantation[10] or degradation,[11] or tissue‐specific effects in the vagina and lower urinary tract.[12] Some have suggested that the regulatory pathway for approval of these materials was inadequate[13] and if well‐done premarketing studies had been performed, such issues would have become manifest before widespread utilization. It is produced directly from the patient's blood and is, superior to synthetic materials in terms of potential adverse effects such as that from foreign body reaction
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