Graft use in transvaginal pelvic organ prolapse repair: a systematic review.
OBJECTIVE
To estimate the anatomic and symptomatic efficacy of graft use in transvaginal prolapse repair and to estimate the rates and describe the spectrum of adverse events associated with graft use.


METHODS
Eligible studies, published between 1950 and November 27, 2007, were retrieved through Medline and bibliography searches.


METHODS
To assess anatomic and symptomatic efficacy of graft use, we used transvaginal prolapse repair studies that compared graft use with either native tissue repair or repair with a different graft. To estimate rates of adverse events from graft use, all comparative studies and case series with at least 30 participants were included. For spectrum of adverse events, all study designs were included.


RESULTS
Eligible studies were extracted onto standardized forms by one reviewer and confirmed by a second reviewer. Comparative studies were classified by vaginal compartment (anterior, posterior, apical, or multiple), graft type (biologic, synthetic-absorbable, synthetic nonabsorbable) and outcome (anatomic, symptomatic). We found 16 comparative studies, including six randomized trials, 37 noncomparative studies with at least 30 women, 11 case series with fewer than 30 women, and 10 case reports of adverse events. One randomized trial and one prospective comparative study evaluating synthetic, nonabsorbable graft use in the anterior compartment reported favorable anatomic and symptomatic outcomes with graft use. Data regarding graft use for posterior and apical compartments or for biologic or synthetic absorbable graft use in the anterior compartment were insufficient to determine efficacy. Rates and spectrum of adverse events associated with graft use included bleeding (0-3%), visceral injury (1-4%), urinary infection (0-19%), graft erosion (0-30%), and fistula (1%). There were insufficient data regarding dyspareunia, sexual, voiding, or defecatory dysfunction.


CONCLUSIONS
Overall, the existing evidence is limited to guide decisions regarding whether to use graft materials in transvaginal prolapse surgery. Adequately powered randomized trials evaluating anatomic and symptomatic efficacy as well as adverse events are needed.
Sung
Vivian W
VW
Alpert Medical School at Brown University, Women and Infants Hospital, Providence, Rhode Island 02903, USA. vsung@wihri.org
Rogers
Rebecca G
RG
Schaffer
Joseph I
JI
Balk
Ethan M
EM
Uhlig
Katrin
K
Lau
Joseph
J
Abed
Husam
H
Wheeler
Thomas L
TL
Morrill
Michelle Y
MY
Clemons
Jeffrey L
JL
Rahn
David D
DD
Lukban
James C
JC
Lowenstein
Lior
L
Kenton
Kimberly
K
Young
Stephen B
SB
D000818:Animals; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D017410:Practice Guidelines as Topic; D013526:Surgical Mesh / Q000009:adverse effects*; D034421:Sus scrofa; D016378:Tissue Transplantation / Q000009:adverse effects* / Q000379:methods; D014183:Transplantation, Heterologous / Q000009:adverse effects*; D014596:Uterine Prolapse / Q000601:surgery*