Augmented repairs and use of interposition grafts in pelvic reconstructive surgery: Part I

Abstract

Because the prevalence of pelvic organ prolapse increases with age and the number of women aged 65 years and older is expected to double in the next 25 years, demand is increasing for subspecialty services related to pelvic floor disorders. Synthetic and biologic interposition grafts have been proposed as a way of augmenting weakened host tissues during pelvic reconstructive surgical procedures because the rate of recurrent pelvic organ prolapse is unacceptably high. Although graft use is rapidly increasing among pelvic reconstructive surgeons, the role of prosthetics is controversial and currently in the process of evolution, with few evidence-based data to support their routine use. This review provides a context for the use of prosthetic grafts in pelvic reconstructive surgery, discusses the properties of both synthetic and biologic materials commonly used during transvaginal reconstructive procedures, and reviews the literature with respect to the role of graft interposition during anterior compartment prolapse repair.

Pelvic organ prolapse (POP) surgery: the evidence for the repairs

“…The latter incidence may actually be higher than the 10–13% rate of dyspareunia reported in some series after POP repairs augmented with mesh [90,93,94]. Additionally, as augmented or unaugmented repairs may be simultaneously performed in other compartments, identifying the problematic repair or site may be challenging [95].…”