Vaginal Mesh Kits for Pelvic Organ Prolapse, Friend or Foe: A Comprehensive Review

Abstract

Graft use in vaginal prolapse surgery has become more common secondary to high failure rates seen with traditional repairs. Mesh has been shown to be successful when suspending the upper portion of the vagina with sacralcolpopexy and its use vaginally is in an attempt to reproduce those results seen from the more invasive abdominal approach. A recent Cochrane review has supported its use in the anterior compartment vaginally as lower failure rates have been shown. Vaginal mesh “kits” have been developed in an attempt to make these surgeries less invasive, more standardized, and easier to perform. One of the problems that does seem to be emerging is the thought that, just because these procedures are now being produced in “kits”, they can be completed by any surgeon. This may not hold true, as these are still advanced techniques that require advanced pelvic surgery skills and, therefore, it is up to surgeons to also understand this and the limitations of these procedures. The current paper reviews the history of the development of mesh kits, the techniques utilized, and the data that have been published to date on results and complications, and recommendations on how to avoid these complications. Although initial studies are encouraging, more will need to be completed prior to the recommendations of general use of these kits in all prolapse patients. We need to have further investigation on proper patient selection, we must continue research on graft composition, and we must continue to develop techniques to minimize complications of needle passage or mesh placement. Even after we gain this knowledge, it will still require advanced surgical skills to complete these types of surgeries, and to help minimize complications and maximize results.

Indications, Contraindications, and Complications of Mesh in Surgical Treatment of Pelvic Organ Prolapse

“…The vaginal epithelium should be well estrogenized both pre- and postoperatively with estrogen cream if necessary. (23) An additional consideration that has been noted in the literature is that of hypersensitivity reactions to synthetic transvaginal mesh. A case-controlled study that included the histological and immunohistochemical analysis of vaginal synthetic mesh explantations in a small population of women noted markers of humorally mediated lymphocytic reaction.…”

The Role of Vaginal Mesh Procedures in Pelvic Organ Prolapse Surgery in View of Complication Risk

“…Furthermore, seven of the seventeen women were noted to have vaginal tightness, and five of the seventeen women reported vaginal shortening [6, 17]. Moore and Miklos discuss the importance of avoiding tension on the levator ani muscle and ligamentous attachments as well as minimizing vaginal epithelium excision and maximizing vaginal estrogen both pre- and postoperatively [23]. Ideal graft augmentation and the avoidance of tensioning can still be complicated by scar tissue formation which may vary from patient to patient.…”

The use of mesh in vaginal prolapse repair: do the benefits justify the risks?

“…Mesh kits for vaginal prolapse repairModified with permission from[13]. RCT, randomized controlled trial; SUI, stress urinary incontinence; UTI, urinary tract infection.…”