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

Abstract

What is known on the subject? and What does the study add? Substantial experience of the outcomes has been gathered regarding the acute and sub‐acute experience with various types of corrective procedures for POP. These include long‐term POP correction as well as more recent recognition of improvement in functional disorders associated with POP such as UI, colorectal dysfunction, and sexual dysfunction. Long‐term follow‐up is available for some of the older types of interventions and current multicentre trials are being accrued with longer term follow‐up for new interventions including mesh‐type repairs. The study adds a condensed and summarized version of the current literature regarding the various interventions for POP and also provides an overview of the current controversies and areas where knowledge is incomplete and in need of further elaboration for definitive answers regarding optimization of surgical care for POP. • Our aim is to summarise the available data on the transvaginal placement of synthetic mesh for pelvic organ prolapse (POP) repair, with a focus on the outcomes and complications of commercial POP‐repair kits. • As the stability and durability of autologous tissues may be questionable, nonabsorbable, synthetic materials are an attractive alternative for providing additional support during POP surgery. These materials are not novel, and most have been used for many years in surgical applications, e.g. hernia repairs. • While theoretically appealing, the implantation of synthetic mesh in the pelvis may be associated with inherent adverse consequences, such as erosion, extrusion, and infection. Additionally, the routine use of these materials may carry potential long‐term complications, such as dyspareunia, chronic pelvic pain, and vaginal distortion. • The success and failure of mesh‐augmented POP repair is related not only to the synthetic material itself, but also to patient‐ and surgeon‐related factors. • Recent warnings by the USA Food and Drug Administration and other groups regarding adverse events further complicate the decision to use synthetic mesh.

Perioperative Complications in Vaginal Mesh Procedures Using Trocar in Pelvic Organ Prolapse Repair

“…The rate of mesh exposure in our study was 0.8 %, lower than those in published studies that reported a rate between 5.8 and 19 % [13,16,21]. The lower rate in the present study may be associated with short follow-up period and surgeon's experience on mesh application.…”

“…Diwadkar et al [13] in a meta-analysis of 24 studies including 3,425 patients and Gomelsky et al [16] in a review of 16 studies including 1,552 patients reported bladder injury as 0.7, 2.6 % and bowel injury as 0.3, 0.3 %, respectively. In the clinical studies, Kato et al [17] in 300 Patients and Caquant et al [18] in 684 patients reported bladder injury as 3.7, 0.7 % and rectal injury as 0.3, 0.3 % respectively.…”

Optimal repair of pelvic organ prolapse: the debate continues

“…Numerous biologic allografts and xenografts have been described for the repair of anterior and posterior compartment defects, and despite variations in the techniques and definitions of success, short-term anatomic cure rates have approached 90%. [24] Unfortunately, the cure rates appear to decline with longer follow-up periods, mirroring the experience with many biologic materials for the surgical correction of SUI. [25] As with pubovaginal and midurethral (MUS) sling surgery, synthetic polymers have been used for the interposition repair of POP.…”

“…Since then, several authors have reported promising outcomes after interposition procedures employing synthetic materials in anterior and posterior compartment repairs. [24] Because synthetic meshes may differ significantly by weave, fiber type, pore size, weight, and stiffness, the positive and adverse outcomes obtained with each synthetic may differ substantially. Once again, an extensive experience with sling surgery has resulted in the conclusion that a macroporous, monofilament, polypropylene mesh has the most favorable biocompatibility profile of all of the current synthetics.…”

“…Several additional studies have since reported severe adverse outcomes after the PIVS, including retropubic abscess, vesicovaginal and rectovaginal fistulae, and sinus formation, with the reoperation rates for complications approaching 25%. [24] Several other manufacturers have introduced prolapse kits into the global marketplace. While a detailed discussion of specific kit properties is beyond the scope of this review, a comparison of mesh kits is available elsewhere.…”