title: Con:  mesh in vaginal surgery:  do the risks outweigh the benefits?
abstract: OBJECTIVE
  To provide an overview regarding the results of transvaginal mesh kits to determine if the known risks outweigh their benefits.
  
  
  RESULTS
  Two Federal and Drug Administration warnings and an ever-increasing amount of data in medical journals reveal a paucity of support regarding routine transvaginal mesh kits for the treatment of pelvic organ prolapse. There have been no studies showing improved quality of life when compared to nonmesh repairs. There have been no studies showing superiority of mesh kits over traditional procedures for posterior or apical prolapses, and minimal data suggesting anatomic benefit of synthetic mesh for anterior compartment repairs. In contrast, transvaginal mesh use significantly increases the complication rate over nonmesh repairs. Some of these complications cause lifelong, irreversible pelvic pain, vaginal shortening, vaginal narrowing, severe vaginal pain, and dyspareunia.
  
  
  CONCLUSIONS
  Transvaginal synthetic mesh kits have minimal to no improved clinical success over nonmesh repairs. Compounding this, mesh kits are clearly associated with multiple relatively common and unique complications without any significant proven benefit for symptomatic relief of pelvic organ prolapse and improvement of quality of life. Continued routine use will needlessly and potentially harm patients permanently without providing any significant benefit.
authors.affiliation: Department of Urology, Section of Female Urology and Voiding Dysfunction, Mayo Clinic, Rochester, Minnesota, USA. Elliott.daniel@mayo.edu
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Elliott
mesh_terms: D004867:Equipment Design; D019317:Evidence-Based Medicine; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D018579:Patient Selection; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D013526:Surgical Mesh / Q000009:adverse effects; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery*