Vaginal mesh kits for pelvic organ prolapse, friend or foe: a comprehensive review.
Graft use in vaginal prolapse surgery has become more common secondary to high failure rates seen with traditional repairs. Mesh has been shown to be successful when suspending the upper portion of the vagina with sacralcolpopexy and its use vaginally isi n an attempt to reproduce those results seen from the more invasive abdominal approach. A recent Cochrane review has supported its use in the anterior compartment vaginally as lower failure rates have been shown. Vaginal mesh "kits" have been developed in an attempt to make these surgeries less invasive, more standardized, and easier to perform. One of the problems that does seem to be emerging is the thought that, just because these procedures are now being produced in "kits", they can be completed by any surgeon. This may not hold true, as these are still advanced techniques that require advanced pelvic surgery skills and, therefore, it is up to surgeons to also understand this and the limitations of these procedures. The current paper reviews the history of the development of mesh kits, the techniques utilized, and the data that have been published to date on results and complications, and recommendations on how to avoid these complications. Although initial studies are encouraging, more will need to be completed prior to the recommendations of general use of these kits in all prolapse patients. We need to have further investigation on proper patient selection, we must continue research on graft composition, and we must continue to develop techniques to minimize complications of needle passage or mesh placement. Even after we gain this knowledge, it will still require advanced surgical skills to complete these types of surgeries, and to help minimize complications and maximize results.
Moore
Robert D
RD
Atlanta Urogynecology Associates, Northside Hospital, Atlanta, GA, USA. Moorer33@hotmail.com
Miklos
John R
JR
D004414:Dyspareunia / Q000601:surgery / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010146:Pain / Q000188:drug therapy; D013526:Surgical Mesh; D014621:Vagina / Q000473:pathology / Q000601:surgery*; D014782:Visceral Prolapse / Q000150:complications / Q000473:pathology / Q000601:surgery*