Graft and Mesh Use in Transvaginal Prolapse Repair: A Systematic Review.
OBJECTIVE
To update clinical practice guidelines on graft and mesh use in transvaginal pelvic organ prolapse repair based on systematic review.


METHODS
Eligible studies, published through April 2015, were retrieved through ClinicalTrials.gov, MEDLINE, and Cochrane databases and bibliography searches.


METHODS
We included studies of transvaginal prolapse repair that compared graft or mesh use with either native tissue repair or use of a different graft or mesh with anatomic and symptomatic outcomes with a minimum of 12 months of follow-up.


RESULTS
Study data were extracted by one reviewer and confirmed by a second reviewer. Studies were classified by vaginal compartment (anterior, posterior, apical, or multiple), graft type (biologic, synthetic absorbable, synthetic nonabsorbable), and outcome (anatomic, symptomatic, sexual function, mesh complications, and return to the operating room). We found 66 comparative studies reported in 70 articles, including 38 randomized trials; quality of the literature has improved over time, but some outcomes still show heterogeneity and limited power. In the anterior vaginal compartment, synthetic nonabsorbable mesh consistently showed improved anatomic and bulge symptom outcomes compared with native tissue repairs based on meta-analyses. Other subjective outcomes, including urinary incontinence or dyspareunia, generally did not differ. Biologic graft or synthetic absorbable mesh use did not provide an advantage in any compartment. Synthetic mesh use in the posterior or apical compartments did not improve success. Mesh erosion rates ranged from 1.4-19% at the anterior vaginal wall, but 3-36% when mesh was placed in multiple compartments. Operative mesh revision rates ranged from 3-8%.


CONCLUSIONS
Synthetic mesh augmentation of anterior wall prolapse repair improves anatomic outcomes and bulge symptoms compared with native tissue repair. Biologic grafts do not improve prolapse repair outcomes in any compartment. Mesh erosion occurred in up to 36% of patients, but reoperation rates were low.
University of Michigan, Ann Arbor, Michigan; the University of Mississippi, Jackson, Mississippi; the University of Maryland School of Medicine, Baltimore, Maryland; Dell Medical School, the University of Texas at Austin, Austin, Texas; Rambam Health Care Campus, Technion Faculty of Medicine, Haifa, Israel; Vanderbilt University Medical Center, Nashville, Tennessee; Women and Infants' Hospital, the Warren Alpert Medical School of Brown University, and Brown University School of Public Health, Providence, Rhode Island; and the Institute for Female Pelvic Medicine and Reconstructive Surgery, North Wales, Pennsylvania.
Megan O
MO
Schimpf
Husam
H
Abed
Tatiana
T
Sanses
Amanda B
AB
White
Lior
L
Lowenstein
Renée M
RM
Ward
Vivian W
VW
Sung
Ethan M
EM
Balk
Miles
M
Murphy
D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D013526:Surgical Mesh; D019737:Transplants / Q000145:classification*