Transvaginal mesh procedures for prolapse, analyzing its outcome rates and complications-literature review

Abstract

Objective of the study: To know the efficacy of transvaginal mesh repair augmented by synthetic polypropylene mesh for pelvic organ prolapse with objective and subjective result of the procedure. Material and methods: Evidence was gathered mostly about transvaginal synthetic polypropylene mesh using the search terms Transvaginal mesh, urinary incontinence, Mesh-complication, anterior prolapse, posterior prolapse, pelvic organ prolapse, vault prolapse, and mesh erosion-From April 2008 to March 2013. Online search range: Pub Med, Medline, RCT, Embase, database, Retrospective study and prospective study. Result: In vaginal Prolapse surgery, graft or mesh is used more frequently than traditional repairs, which has high failure rates. Vaginal approach of mesh placement and suspension of the upper part of the vagina is seen to be more appropriate and successful, showing effects similar to that of the invasive abdominal approach. Because of its lower failure rates it is recently supported by Cochrane review as well. To make such kinds of surgeries easier, more standard and least invasive vaginal kits are being upgraded. It is said that every surgeon can perform the procedure with mesh kits easily, but it is not so. It needs advance pelvic surgery skills, a lot to understand and the limitations of the technique as well. This current paper focuses the needs for the development of the kit, how to use it, results and complications till date and the techniques how to overcome the complications. Before recommending the technique for general use in all Prolapse patients, a lot of things like investigation on proper patient selection, continue research on graft composition, techniques that minimize complications of needle passes or mesh placement should be understood thoroughly. Apart from these we still should have more surgical skills to perform the procedures, to reduce complications and increase better results. Conclusion: Transvaginal repair using a synthetic polypropylene transvaginal mesh is a feasible and efficient procedure for the treatment of pelvic organ prolapse with less significant complications. Monofilament macro porous synthetic polypropylene mesh is effective, due to its low risk of infection and foreign body reaction. Proper patient selection is the best way to avoid unnecessary complications.