• Megan O Schimpf, Husam Abed, Tatiana Sanses, Amanda B White, Lior Lowenstein, Renée M Ward, Vivian W Sung, Ethan M Balk, Miles Murphy, and Society of Gynecologic Surgeons Systematic Review Group.
• 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.
• Obstet Gynecol. 2016 Jul 1; 128 (1): 81-91.

ObjectiveTo update clinical practice guidelines on graft and mesh use in transvaginal pelvic organ prolapse repair based on systematic review.Data SourcesEligible studies, published through April 2015, were retrieved through ClinicalTrials.gov, MEDLINE, and Cochrane databases and bibliography searches.Methods Of Study SelectionWe 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.Tabulation, Integration, And ResultsStudy 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%.ConclusionSynthetic 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.

17 keywords...

hide…