Abstract
Pelvic organ prolapse and stress urinary incontinence are common conditions for which approximately 11% of women will undergo surgical intervention in their lifetime. The use of vaginal mesh for pelvic organ prolapse and stress urinary incontinence rose rapidly in the early 2000s as over 100 mesh products were introduced into the clinical armamentarium with little regulatory oversight for their use. US Food and Drug Administration Public Health Notifications in 2008 and 2011, as well as reclassification of transvaginal mesh for prolapse to class III in early 2016, were a response to debilitating complications associated with transvaginal mesh placement in many women. The midurethral sling has not been subject to the same reclassification and continues to be endorsed as the “gold standard” for surgical management of stress urinary incontinence by subspecialty societies. However, litigators have not differentiated between mesh for prolapse and mesh for incontinence. As such, all mesh, including that placed for stress urinary incontinence, faces continued controversy amidst an uncertain future. In this article, we review the background of the mesh controversy, recent developments, and the anticipated role of mesh in surgery for prolapse and stress urinary incontinence going forward.
Highlights
Pelvic organ prolapse (POP) is a condition involving the descent of the pelvic organs, such as the bladder, rectum, and uterus or proximal vagina beyond their normal anatomic location
Similar risks increase the likelihood of developing stress urinary incontinence (SUI), which may result from loss of pelvic support leading to urethral descent or direct damage to the continence mechanism resulting in intrinsic sphincter deficiency
In July 2011, the Food and Drug Administration (FDA) released a second Public Health Notification, which stated that “serious complications associated with surgical mesh for transvaginal repair of pelvic organ prolapse are not rare”[17]
Summary
Faculty Reviews are review articles written by the prestigious Members of Faculty Opinions. The articles are commissioned and peer reviewed before publication to ensure that the final, published version is comprehensive and accessible. The reviewers who approved the final version are listed with their names and affiliations. Keywords pelvic organ prolapse , stress urinary incontinence , transvaginal mesh. 2. Gopal Badlani, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA. Any comments on the article can be found at the end of the article
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