Pelvic floor reconstructive surgery: which aspects remain controversial?
OBJECTIVE
The article focuses on recently published original and review papers on current controversial aspects of pelvic reconstructive surgery.


RESULTS
A detailed Medline search was performed on records published in the previous 12 months. Controversial areas concerning which important work has been recently published include (a) prophylactic treatment of stress urinary incontinence, (b) the use of prosthetic materials (particularly for anterior segment reconstruction), (c) laparoscopic surgery. The considerations of the recent International Consultation on Incontinence are also reported. Other controversial areas in the field of pelvic reconstructive surgery such as the question of uterine preservation during the surgery for uterovaginal prolapse provided no significant new data in the period of this review.


CONCLUSIONS
In this evolving field, there is still poor standardization of what constitutes anatomical and functional cure. The transvaginal approach is the most promising of all techniques, and new techniques are evolved mainly in this area. There continues to be a need for multicenter prospective randomized trials providing level I evidence. Recurrence rates, particularly in the anterior wall, are still unacceptably high. Evidence is urgently needed to decide whether the use of prosthetic materials may provide the answer, if so, which material and which method?
Natale
Franca
F
Department of Urogynecology, University Tor Vergata, San Carlo-IDI Hospital, via Aurelia 275, 00165 Rome, Italy.
Weir
Jennifer M
JM
Cervigni
Mauro
M
D052858:Cystocele / Q000601:surgery; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D017773:Pelvic Floor / Q000601:surgery*; D019919:Prosthesis Implantation; D014550:Urinary Incontinence, Stress / Q000601:surgery; D013519:Urogenital Surgical Procedures / Q000379:methods*; D014596:Uterine Prolapse / Q000601:surgery