, Volume 14, Issue 6, pp 365-366
Date: 02 Dec 2003

The use and misuse of prosthetic materials in reconstructive pelvic surgery: does the evidence support our surgical practice?

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The last 50 years of female urology and reconstructive pelvic surgery have seen many great ideas but few real innovations that have survived the test of time. The Marshall–Marchetti–Krantz procedure, fascial slings, bulking agents and tension-free slings are some examples of surgical innovations that have improved the care of affected patients. Other ideas – bone anchors come to mind – will probably not provide the results their inventors had hoped. Many surgeons like to try new techniques, and under certain circumstances they should be encouraged to do so. However, we need to step back occasionally and examine the evidence of what we do; without periodic reassessment, we risk losing our way by using techniques that really may not be beneficial to our patients.

Let us examine the common use of various synthetic and biologic prosthetic materials in pelvic reconstruction. Will some of these materials become lasting surgical innovations, or are they destined to go the way of the bead-chain ...