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Do we need meshes in pelvic floor reconstruction?

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Abstract

Objectives

Transvaginally placed mesh in pelvic reconstructive surgery for women with pelvic organ prolapse has gained popularity because of excellent anatomical outcomes, but postoperative mesh-related complications have lead to a number of cautious reviews and warnings. This review focuses on functional outcomes after synthetic transvaginal mesh placement.

Methods

MEDLINE database was searched from 2010 to August 2011 for original articles on transvaginal mesh surgery for pelvic organ prolapse not included in recent reviews. The following search terms were used: pelvic organ prolapse, genital prolapse, cystocele, rectocele and mesh, synthetic graft, and repair. Studies were assessed and appropriate data extracted and tabularized. Studies were excluded if the follow-up time was less than 12 months and if studies did not contain original data or data on subjective outcome.

Results

Eleven studies irregularly reported functional outcomes. After trocar-guided transobturator vaginal mesh surgery, symptomatic recurrence of pelvic organ prolapse was reported between 7 and 33%. If analyzed cumulatively, 76 of 370 patients (21%) complained of prolapse symptoms postoperatively. De novo stress urinary incontinence occurred in 12–17% and persisted in up to 68% after trocar-guided mesh surgery. De novo dyspareunia was present between 2 and 15%, worsened or de novo dyspareunia between 25 and 44%. Deteriorating coital incontinence was described in 6 of 16 women after anterior Prolift in one trial.

Conclusions

When counseling women for pelvic reconstructive surgery, we should provide them with evidence-based information on functional outcomes and subsequently take the patient’s concerns and preferences into account. Pelvic floor symptoms were scarcely reported in reviewed trials, but demonstrated a worse scenario than anatomical outcomes.

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References

  1. Maher C, Feiner B, Baessler K, Adams EJ, Hagen S and Glazener CM (2010) Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev 14:CD004014

    Google Scholar 

  2. Sentilhes L, Descamps P, Marpeau L (2009) Graft use in transvaginal pelvic organ prolapse repair: a systematic review. Obstet Gynecol 113:952 author reply 952

    PubMed  Google Scholar 

  3. Moore RD, Miklos JR (2009) Vaginal mesh kits for pelvic organ prolapse, friend or foe: a comprehensive review. Sci World J 9:163–189

    Article  Google Scholar 

  4. Feiner B, Jelovsek JE, Maher C (2009) Efficacy and safety of transvaginal mesh kits in the treatment of prolapse of the vaginal apex: a systematic review. BJOG 116:15–24

    PubMed  CAS  Google Scholar 

  5. Diwadkar GB, Barber MD, Feiner B, Maher C, Jelovsek JE (2009) Complication and reoperation rates after apical vaginal prolapse surgical repair: a systematic review. Obstet Gynecol 113:367–373

    PubMed  Google Scholar 

  6. Sung VW, Rogers RG, Schaffer JI, Balk EM, Uhlig K, Lau J, Abed H, Wheeler TL 2nd, Morrill MY, Clemons JL, Rahn DD, Lukban JC, Lowenstein L, Kenton K, Young SB (2008) Graft use in transvaginal pelvic organ prolapse repair: a systematic review. Obstet Gynecol 112:1131–1142

    Article  PubMed  Google Scholar 

  7. Nguyen JN (2008) The use of grafts for anterior vaginal prolapse repair: pros and cons. Curr Opin Obstet Gynecol 20:501–505

    Article  PubMed  Google Scholar 

  8. Jakus SM, Shapiro A, Hall CD (2008) Biologic and synthetic graft use in pelvic surgery: a review. Obstet Gynecol Surv 63:253–266

    Article  PubMed  Google Scholar 

  9. De Ridder D (2008) Should we use meshes in the management of vaginal prolapse? Curr Opin Urol 18:377–382

    Article  PubMed  Google Scholar 

  10. South M, Amundsen CL (2007) Pelvic organ prolapse: a review of the current literature. Minerva Ginecol 59:601–612

    PubMed  CAS  Google Scholar 

  11. Jia X, Glazener C, Mowatt G, MacLennan G, Bain C, Fraser C, Burr J (2008) Efficacy and safety of using mesh or grafts in surgery for anterior and/or posterior vaginal wall prolapse: systematic review and meta-analysis. BJOG 115:1350–1361

    Article  PubMed  CAS  Google Scholar 

  12. Zimmerman CW, Sheth SS (2011) Anterior, posterior and apical vaginal reconstruction with and without bolsters. Best Pract Res Clin Obstet Gynaecol 25:167–174

    Article  PubMed  Google Scholar 

  13. Gomelsky A, Penson DF, Dmochowski RR (2011) Pelvic organ prolapse (POP) surgery: the evidence for the repairs. BJU Int 107:1704–1719

    Article  PubMed  Google Scholar 

  14. Morrisroe S, Lee U, Raz S (2011) The use of mesh in vaginal prolapse repair: do the benefits justify the risks? Curr Opin Urol 20:275–279

    Article  Google Scholar 

  15. McIntyre M, Goudelocke C, Rovner ES (2011) An update on surgery for pelvic organ prolapse. Curr Opin Urol 20:490–494

    Article  Google Scholar 

  16. Baessler K, Maher CF (2006) Mesh augmentation during pelvic-floor reconstructive surgery: risks and benefits. Curr Opin Obstet Gynecol 18:560–566

    Article  PubMed  Google Scholar 

  17. Maher CM, Feiner B, Baessler K, Glazener CM (2011) Surgical management of pelvic organ prolapse in women: the updated summary version Cochrane review. Int Urogynecol J 22:1445–1457

    Article  PubMed  Google Scholar 

  18. Baessler K, O’Neill S, Maher C (2006) Prevalence, incidence, progression and regression of pelvic organ prolapse in a community cohort: results of a 5-year longitudinal study. Neurourol Urodynam 25:520–522

    Google Scholar 

  19. Staskin D et al (2009) Patient-reported outcome assessment. In: Abrams P, Cardozo L, Khoury S, Wein A (eds) Incontinence, 4th edn. Health Publication Ltd, Paris

  20. Kelleher CJ, Cardozo LD, Khullar V, Salvatore S (1997) A new questionnaire to assess the quality of life of urinary incontinent women. Br J Obstet Gynaecol 104:1374–1379

    Article  PubMed  CAS  Google Scholar 

  21. Baessler K, O’Neill SM, Maher CF, Battistutta D (2009) Australian pelvic floor questionnaire: a validated interviewer-administered pelvic floor questionnaire for routine clinic and research. Int Urogynecol J Pelvic Floor Dysfunct 20:149–158

    Article  PubMed  Google Scholar 

  22. Barber MD, Kuchibhatla MN, Pieper CF, Bump RC (2001) Psychometric evaluation of 2 comprehensive condition-specific quality of life instruments for women with pelvic floor disorders. Am J Obstet Gynecol 185:1388–1395

    Article  PubMed  CAS  Google Scholar 

  23. Jackson S, Donovan J, Brookes S, Eckford S, Swithinbank L, Abrams P (1996) The bristol female lower urinary tract symptoms questionnaire: development and psychometric testing. Br J Urol 77:805–812

    Article  PubMed  CAS  Google Scholar 

  24. Shumaker SA, Wyman JF, Uebersax JS, McClish D, Fantl JA (1994) Health-related quality of life measures for women with urinary incontinence: the incontinence impact questionnaire and the urogenital distress inventory. Continence program in women (CPW) research group. Qual Life Res 3:291–306

    Article  PubMed  CAS  Google Scholar 

  25. Kammerer-Doak D (2009) Assessment of sexual function in women with pelvic floor dysfunction. Int Urogynecol J Pelvic Floor Dysfunct 20(Suppl 1):S45–S50

    PubMed  Google Scholar 

  26. Abrams P, Avery K, Gardener N and Donovan J (2006) The International Consultation on Incontinence Modular Questionnaire: http://www.iciq.net. J Urol 175:1063–1066 (discussion 1066)

    Google Scholar 

  27. Ek M, Altman D, Falconer C, Kulseng-Hanssen S, Tegerstedt G (2010) Effects of anterior trocar guided transvaginal mesh surgery on lower urinary tract symptoms. Neurourol Urodyn 29:1419–1423

    Article  PubMed  Google Scholar 

  28. Altman D, Vayrynen T, Engh ME, Axelsen S, Falconer C (2011) Anterior colporrhaphy versus transvaginal mesh for pelvic-organ prolapse. N Engl J Med 364:1826–1836

    Article  PubMed  CAS  Google Scholar 

  29. Milani AL, Hinoul P, Gauld JM, Sikirica V, van Drie D, Cosson M (2011) Trocar-guided mesh repair of vaginal prolapse using partially absorbable mesh: 1 year outcomes. Am J Obstet Gynecol 204:74 e1–74 e8

    Article  Google Scholar 

  30. Maher C, O’Rourke P (2011) Trocar-guided mesh compared with conventional vaginal repair in recurrent prolapse: a randomized controlled trial. Obstet Gynecol 117:1435–1436 author reply 1436–1437

    Article  PubMed  Google Scholar 

  31. Fayyad AM, North C, Reid FM, Smith AR (2010) Prospective study of anterior transobturator mesh kit (prolift) for the management of recurrent anterior vaginal wall prolapse. Int Urogynecol J 22:157–163

    Article  PubMed  Google Scholar 

  32. Feiner B, Gietelink L, Maher C (2010) Anterior vaginal mesh sacrospinous hysteropexy and posterior fascial plication for anterior compartment dominated uterovaginal prolapse. Int Urogynecol J 21:203–208

    Article  PubMed  Google Scholar 

  33. Zyczynski HM, Carey MP, Smith AR, Gauld JM, Robinson D, Sikirica V, Reisenauer C, Slack M (2011) One-year clinical outcomes after prolapse surgery with nonanchored mesh and vaginal support device. Am J Obstet Gynecol 203:587 e1–587 e8

    Google Scholar 

  34. Moore RD, Beyer RD, Jacoby K, Freedman SJ, McCammon KA, Gambla MT (2010) Prospective multicenter trial assessing type I, polypropylene mesh placed via transobturator route for the treatment of anterior vaginal prolapse with 2-year follow-up. Int Urogynecol J 21:545–552

    Article  PubMed  Google Scholar 

  35. Jacquetin B, Fatton B, Rosenthal C, Clave H, Debodinance P, Hinoul P, Gauld J, Garbin O, Berrocal J, Villet R, Salet Lizee D, Cosson M (2010) Total transvaginal mesh (TVM) technique for treatment of pelvic organ prolapse: a 3-year prospective follow-up study. Int Urogynecol J 21:1455–1462

    Article  PubMed  Google Scholar 

  36. Long CY, Hsu CS, Jang MY, Liu CM, Chiang PH, Tsai EM (2010) Comparison of clinical outcome and urodynamic findings using “Perigee and/or Apogee” versus “Prolift anterior and/or posterior” system devices for the treatment of pelvic organ prolapse. Int Urogynecol J 22:233–239

    Article  PubMed  Google Scholar 

  37. Alcalay M, Cosson M, Livneh M, Lucot JP, Von Theobald P (2010) Trocarless system for mesh attachment in pelvic organ prolapse repair–1-year evaluation. Int Urogynecol J 22:551–556

    Article  Google Scholar 

  38. Kudish BI, Iglesia CB (2011) Posterior wall prolapse and repair. Clin Obstet Gynecol 53:59–71

    Article  Google Scholar 

  39. de Tayrac R, Devoldere G, Renaudie J, Villard P, Guilbaud O, Eglin G (2007) Prolapse repair by vaginal route using a new protected low-weight polypropylene mesh: 1-year functional and anatomical outcome in a prospective multicentre study. Int Urogynecol J Pelvic Floor Dysfunct 18:251–256

    Article  PubMed  Google Scholar 

  40. Milani AL, Heidema WM, van der Vloedt WS, Kluivers KB, Withagen MI, Vierhout ME (2008) Vaginal prolapse repair surgery augmented by ultra lightweight titanium coated polypropylene mesh. Eur J Obstet Gynecol Reprod Biol 138:232–238

    Article  PubMed  CAS  Google Scholar 

  41. Letouzey V, Deffieux X, Gervaise A, Mercier G, Fernandez H, de Tayrac R (2010) Trans-vaginal cystocele repair using a tension-free polypropylene mesh: more than 5 years of follow-up. Eur J Obstet Gynecol Reprod Biol 151:101–105

    Article  PubMed  Google Scholar 

  42. Hung MJ, Liu FS, Shen PS, Chen GD, Lin LY, Ho ES (2004) Factors that affect recurrence after anterior colporrhaphy procedure reinforced with four-corner anchored polypropylene mesh. Int Urogynecol J Pelvic Floor Dysfunct 15:399–406 discussion 406

    Article  PubMed  CAS  Google Scholar 

  43. Feiner B, Maher C (2010) Vaginal mesh contraction: definition, clinical presentation, and management. Obstet Gynecol 115:325–330

    Article  PubMed  Google Scholar 

  44. Achtari C, Hiscock R, O’Reilly BA, Schierlitz L, Dwyer PL (2005) Risk factors for mesh erosion after transvaginal surgery using polypropylene (Atrium) or composite polypropylene/polyglactin 910 (Vypro II) mesh. Int Urogynecol J Pelvic Floor Dysfunct 16:389–394

    Article  PubMed  Google Scholar 

  45. Wu JM, Wells EC, Hundley AF, Connolly A, Williams KS, Visco AG (2006) Mesh erosion in abdominal sacral colpopexy with and without concomitant hysterectomy. Am J Obstet Gynecol 194:1418–1422

    Article  PubMed  Google Scholar 

  46. Tan-Kim J, Menefee SA, Luber KM, Nager CW, Lukacz ES (2011) Prevalence and risk factors for mesh erosion after laparoscopic-assisted sacrocolpopexy. Int Urogynecol J 22:205–212

    Article  PubMed  Google Scholar 

  47. Ganj FA, Ibeanu OA, Bedestani A, Nolan TE, Chesson RR (2009) Complications of transvaginal monofilament polypropylene mesh in pelvic organ prolapse repair. Int Urogynecol J Pelvic Floor Dysfunct 20:919–925

    Article  PubMed  Google Scholar 

  48. Nosti PA, Lowman JK, Zollinger TW, Hale DS, Woodman PJ (2009) Risk of mesh erosion after abdominal sacral colpoperineopexy with concomitant hysterectomy. Am J Obstet Gynecol 201:541 e1–544 e1

    Article  Google Scholar 

  49. Brizzolara S, Pillai-Allen A (2003) Risk of mesh erosion with sacral colpopexy and concurrent hysterectomy. Obstet Gynecol 102:306–310

    Article  PubMed  Google Scholar 

  50. Maher CF, Cary MP, Slack MC, Murray CJ, Milligan M, Schluter P (2001) Uterine preservation or hysterectomy at sacrospinous colpopexy for uterovaginal prolapse? Int Urogynecol J Pelvic Floor Dysfunct 12:381–384 discussion 384–385

    Article  PubMed  CAS  Google Scholar 

  51. Diwan A, Rardin CR, Kohli N (2004) Uterine preservation during surgery for uterovaginal prolapse: a review. Int Urogynecol J Pelvic Floor Dysfunct 15:286–292

    PubMed  Google Scholar 

  52. Diwan A, Rardin CR, Strohsnitter WC, Weld A, Rosenblatt P, Kohli N (2006) Laparoscopic uterosacral ligament uterine suspension compared with vaginal hysterectomy with vaginal vault suspension for uterovaginal prolapse. Int Urogynecol J Pelvic Floor Dysfunct 17:79–83

    Article  PubMed  Google Scholar 

  53. Maher C, Baessler K (2006) Surgical management of anterior vaginal wall prolapse: an evidencebased literature review. Int Urogynecol J Pelvic Floor Dysfunct 17:195–201

    Article  PubMed  Google Scholar 

  54. Maher CF, Carey MP, Murray CJ (2001) Laparoscopic suture hysteropexy for uterine prolapse. Obstet Gynecol 97:1010–1014

    Article  PubMed  CAS  Google Scholar 

  55. Jelovsek JE, Barber MD, Karram MM, Walters MD, Paraiso MF (2008) Randomised trial of laparoscopic Burch colposuspension versus tension-free vaginal tape: long-term follow up. BJOG 115:219–225 discussion 225

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Pelvic Floor Unit Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany

    Kaven Baessler

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  1. Kaven Baessler
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Correspondence to Kaven Baessler.

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Baessler, K. Do we need meshes in pelvic floor reconstruction?. World J Urol 30, 479–486 (2012). https://doi.org/10.1007/s00345-011-0794-9

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  • DOI: https://doi.org/10.1007/s00345-011-0794-9

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