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Overview of transvaginal placement of mesh for prolapse and stress urinary incontinence

Authors
Emanuel C Trabuco, MD, MS
John B Gebhart, MD, MS
Section Editor
Linda Brubaker, MD, FACS, FACOG
Deputy Editor
Kristen Eckler, MD, FACOG

INTRODUCTION

Reconstructive materials (synthetic, autograft, allograft and xenograft) may be used for surgical treatment of either pelvic organ prolapse (POP) or stress urinary incontinence (SUI). Of the reconstructive materials, synthetic nonabsorbable polypropylene mesh (mesh) has become the dominant reconstructive material for gynecologic surgery to reduce high failure rates seen with traditional colporrhaphy. However, concerns have been raised about the safety of transvaginal placement of these materials. This topic will provide an overview of issues related to transvaginal mesh for surgical treatment of POP or SUI.

Both mesh-based abdominal prolapse repairs, non-mesh based repairs (referred to as non-graft, non-mesh, traditional, suture-only, or native tissue procedures), and nonsurgical treatment of POP and SUI are reviewed separately. (See "Pelvic organ prolapse in women: Choosing a primary surgical procedure", section on 'Abdominal route' and "Pelvic organ prolapse in women: An overview of the epidemiology, risk factors, clinical manifestations, and management", section on 'Management options' and "Treatment of urinary incontinence in women".)

GRAFT MATERIAL

Synthetic mesh — Synthetic materials are available as both absorbable and non-absorbable mesh. Nonabsorbable synthetic materials are generally described by type, a classification based on pore size and weave (figure 1) [1]. Type 1 macroporous monofilament polypropylene mesh is typically used for reconstructive pelvic surgery. (See "Reconstructive materials used in surgery: Classification and host response".)

Compared with biologic grafts, advantages of synthetic materials include: greater availability (does not require harvesting), lack of risk of donor-to-host infectious disease transmission, and cost-effectiveness. The incidence of complications has not been linked to a single product [2].

Transvaginal mesh kits — We do not use commercial mesh kits (referred to as mesh kits or trocar-guided mesh kits) because of high rates of complication and reoperation without a demonstrated benefit in patient awareness of prolapse recurrence. In a meta-analysis of three trials that compared native tissue repair with a variety of mesh kits, of the women who received a mesh kit, 18 percent had a mesh exposure and 9 percent underwent surgical correction of mesh exposure [3]. The total reoperation rate was three times greater for women with mesh kits than women with native tissue repair (relative risk [RR] 3.1, 95% CI 1.3-7.3). While the recurrence rate on examination was higher for the native tissue group than the mesh group (RR 2.0, 95% CI 1.3-3.1), there was no difference in patient perception of prolapse between the groups (RR 1.3, 95% CI 0.6-1.7). Thus, the women receiving mesh kits had higher complication rates but similar outcomes from the patients’ assessments.

                           

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Literature review current through: Nov 2016. | This topic last updated: Fri Jun 03 00:00:00 GMT+00:00 2016.
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