Optimizing Safety and Appropriateness of Graft Use in Pelvic Reconstructive Surgery: Introduction to the 2nd IUGA Grafts Roundtable

Abstract

Urogynecologic surgeons, regulatory bodies, and their patients are currently embroiled in a divisive debate regarding the appropriate use of grafts in the vaginal repair of pelvic organ prolapse. This debate has spilled over onto the public and legal domains with lightning speed thanks in great part to the widespread marketing of new mesh kits by surgical device companies and prompt adoption of new techniques by pelvic surgeons, as well as widespread access to an uncensored internet. “Good evidence either way” is slow to come, as with most innovative surgical progress. We have been keenly aware that this was likely to happen. It is reported that over 300,000 prolapse procedures are performed annually in the USA [1]. It is unknown exactly how many mesh kits are implanted per year, but it is likely a growing volume due to widespread marketing and increased surgeon training. Although the currently available kits have basic similarities, including the use of lightweight type 1 polypropylene mesh, they did not begin that way. It was our growing concern regarding the use of a wide variety of reconstructive materials—and their unknown postimplantation behavior—that led us to sponsor the initial International Urogynecological Association (IUGA) Grafts Roundtable in 2005 [2]. The goals of that meeting included: