Scientific basis for use of grafts during vaginal reconstructive procedures

Abstract

The use of graft material and mesh in the setting of pelvic organ prolapse surgery has gained increasing popularity and attention in spite of lack of scientific evidence to support their use. The objective of this review is to discuss available synthetic and biologic graft materials, review operative techniques, and evaluate the anatomic and functional results of published data on graft augmented prolapse repairs and antiincontinence procedures. Natural biologic graft materials (such as fascia lata) have been used to augment prolapse surgery and have a theoretical advantage of causing less erosions; however, a renewed interest in the employment of synthetic mesh in the anterior and posterior segments has increased, partly due to the need to find improved materials with less inconsistent material strength. The insertion of 'tension-free' meshes for anterior and posterior vaginal wall prolapse may be promising, but studies with longer follow-up are necessary to determine their true efficacy and safety profile. The recent introduction of newer graft materials and minimally invasive surgical techniques for pelvic organ prolapse repair and stress incontinence has rapidly grown, despite the relative lack of evidence-based information to document their long-term efficacy and safety. Their current use must take into account the risk-benefit profile and be individualized for each surgical candidate. The ultimate goal is to correct both the anatomic and functional derangements seen in this patient population, while improving quality of life.