Native Tissue Surgery for Prolapse versus Graft/Mesh Use: Current Trends in Reconstructive Surgery

Abstract

Pelvic organ prolapse, characterized by a descent of the vaginal walls or vaginal apex, can be treated surgically in symptomatic women who decline or have failed conservative management. Because prolapse can recur after surgery, mesh and biologic grafts have been developed to augment repairs. Use of transvaginal mesh materials quickly increased in the early twenty-first century; however, since the FDA warnings about potential serious complications from transvaginal mesh in 2008 and 2011, use has decreased dramatically, and many mesh products were removed from the market. Even through the peak of mesh use in prolapse surgery, native tissue repairs have remained the most common type of repair.

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“…In cases where the opportunity for surgical intervention exists, choice in this area is limited. Options include repair of damaged sphincter tissue, use of mesh and tape to support the pelvic floor and associated structures, sacral nerve stimulation and implantation of 'neosphincters' to augment function of the biological sphincters (22)(23)(24)(25). Figure 3.…”

“…Options include repair of damaged sphincter tissue, use of mesh and tape to support the pelvic floor and associated structures, sacral nerve stimulation and implantation of 'neosphincters' to augment function of the biological sphincters. [22][23][24][25] Multi-morbidity By 2050, the global population of older persons is projected to be more than double its size from that at Outputs from key clinical tools used to assess and diagnose FI: (a) high-resolution anorectal manometry shows the pressure distribution along the anal canal; 14 (b) evacuation defaecography shows movement of anatomical structures and anorectal angle change during defaecation, helping to highlight abnormalities; 15 and (c) endoanal ultrasonography provides cross-sectional views of the anal canal enabling identification of muscle and soft tissue defects. 16 2015, reaching nearly 9.8 billion.…”