title: Vaginal approaches to pelvic organ prolapse repair.
abstract: OBJECTIVE
  Changes in perception regarding the safety of mesh require a review of vaginal approaches for pelvic organ prolapse surgery with and without mesh. The purpose of this article is to examine the implications of the negative stigma toward mesh and review the outcomes of different vaginal approaches to pelvic organ prolapse repair.
  
  
  RESULTS
  Defining a successful outcome of pelvic organ prolapse surgery from a symptomatic perspective instead of an anatomic perspective reveals that native tissue repairs and graft repairs are equivalent. In the posterior and apical compartments, a review of multiple studies shows that native tissue and graft transvaginal repairs have similar anatomic results except that native tissue repairs do not carry the risk of mesh extrusion. After failure of a native tissue repair, the majority of surgeons will use a graft-augmented repair.
  
  
  CONCLUSIONS
  Controversy exists about how to define a successful outcome after pelvic organ prolapse surgery. Native tissue repairs require a more individualized approach than mesh-augmented repairs because native tissue requires the surgeon to closely examine the patient to determine the exact compartment and location that is affected before deciding on a surgical approach.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, A1302 Medical Center North, Nashville, TN 37232-2765, USA. david.osborn@vanderbilt.edu
authors.forename: David J
authors.initials: DJ
authors.lastname: Osborn
authors.forename: W Stuart
authors.initials: WS
authors.lastname: Reynolds
authors.forename: Roger
authors.initials: R
authors.lastname: Dmochowski
mesh_terms: D005260:Female; D006801:Humans; D056887:Pelvic Organ Prolapse / Q000175:diagnosis / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D018570:Risk Assessment; D012307:Risk Factors; D013526:Surgical Mesh; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D014621:Vagina / Q000601:surgery*