Is There Still a Role for Transvaginal Mesh in Treatment of Pelvic Organ Prolapse?

Abstract

The purpose of this review is to facilitate an understanding of where TVM may still serve a role in POP repair surgery. It provides a broad overview of evidence examining the differences in outcomes between TVM and other surgical interventions for POP. Although in 2003 TVM was introduced into the treatment paradigm for POP with limited data regarding safety and efficacy, the body of literature that has accrued in years gone by finds a narrow list of utility. Certain sub-categories of POP patients at increased risk for recurrence could potentially benefit from TVM placement for POP, including those with advanced preoperative vaginal prolapse stage (stage III or stage IV), levator avulsion, or increased levator hiatal area during Valsalva on ultrasound; in addition, perhaps those that are not surgical candidates for laparoscopic sacrocolpopexy. That being said, the informed consent should use a benefit-risk assessment of intervention, avoiding a discussion solely based on risk of recurrence of POP. Despite the loss of many TVM kits from the market, the role for TVM continues to be elucidated with registries and long-term data analysis. TVM does not have a role in routine POP surgery, but may have benefit in a narrow segment of patients at increased risk for recurrence. Understanding the challenges presented by the use of TVM products, the future of surgical repair of POP may involve next-generation biomimetic implants, yielding an entirely new armamentarium in years to come.