Mesh augmentation during pelvic-floor reconstructive surgery: risks and benefits

Abstract

Synthetic meshes are increasingly used in the surgical management of stress urinary incontinence and pelvic-organ prolapse in an attempt to improve success rates and increase the longevity of repairs. This review describes and analyses complications following pelvic-floor procedures employing synthetic meshes. Type I monofilament polypropylene mesh with a large pore size is currently the mesh of choice. Chronic inflammation is a typical host response, whereas acute inflammation and predominant CD20+ lymphocyte infiltration represent an adverse host reaction and may result in defective healing. Mesh properties influence the performance and complication rate. Mesh-related complications after midurethral slings and mesh sacrocolpopexies with monofilament polypropylene are rare. An up to 26% mesh erosion rate and up to 38% dyspareunia rate with vaginally introduced mesh for pelvic-organ prolapse repair has been reported. Concurrent hysterectomy seems to increase mesh erosion rates. Surgeons should be aware of the potential complications of synthetic meshes. Until data on the safety and efficacy of synthetic mesh in vaginal reconstructive surgery emerge, its routine use outside of clinical trials cannot be recommended.