Should we use meshes in the management of vaginal prolapse?

Abstract

The aim of this review is to discuss the latest developments in the use of synthetic meshes for vaginal prolapse repair. The literature addressing the use of meshes in vaginal reconstructive surgery is limited. Few studies show a sufficient high level of evidence. Early studies cannot demonstrate a clear advantage of meshes and vaginally placed meshes show a high erosion rate (>10%). Despite this, pelvic organ prolapse surgery with meshes is increasing. Recent publications report better results and lower erosion rates (0-6.9%) that approach those of laparoscopic or open sacrocolpopexy (3-5%). Several recent studies suggest that transvaginal implantation of polypropylene mesh is an effective and safe technique for the correction of anterior prolapse. Synthetic meshes are used less frequently for posterior prolapse repair as traditional repair with native tissue yields good results. The recent results on synthetic meshes for total prolapse repair are encouraging. The improved mesh designs and prosthetic kits are important developments and might reduce the risk for complications. Mesh-related complications are manageable. Recent publications suggest that synthetic meshes are promising for vaginal prolapse repair. Long-term controlled studies will have to confirm the effectiveness and safety of new meshes and will have to include more functional data on sexuality and quality of life, before transvaginal meshes can be accepted as routine surgery.