Advertisement

Current Bladder Dysfunction Reports

, Volume 13, Issue 4, pp 257–261 | Cite as

Is There Still a Role for Transvaginal Mesh in Treatment of Pelvic Organ Prolapse?

  • Seth A. CohenEmail author
Stress Incontinence and Prolapse (S Reynolds, Section Editor)
  • 15 Downloads
Part of the following topical collections:
  1. Topical Collection on Stress Incontinence and Prolapse

Abstract

Purpose of Review

The purpose of this review is to facilitate an understanding of where TVM may still serve a role in POP repair surgery. It provides a broad overview of evidence examining the differences in outcomes between TVM and other surgical interventions for POP.

Recent Findings

Although in 2003 TVM was introduced into the treatment paradigm for POP with limited data regarding safety and efficacy, the body of literature that has accrued in years gone by finds a narrow list of utility. Certain sub-categories of POP patients at increased risk for recurrence could potentially benefit from TVM placement for POP, including those with advanced preoperative vaginal prolapse stage (stage III or stage IV), levator avulsion, or increased levator hiatal area during Valsalva on ultrasound; in addition, perhaps those that are not surgical candidates for laparoscopic sacrocolpopexy. That being said, the informed consent should use a benefit-risk assessment of intervention, avoiding a discussion solely based on risk of recurrence of POP.

Summary

Despite the loss of many TVM kits from the market, the role for TVM continues to be elucidated with registries and long-term data analysis. TVM does not have a role in routine POP surgery, but may have benefit in a narrow segment of patients at increased risk for recurrence. Understanding the challenges presented by the use of TVM products, the future of surgical repair of POP may involve next-generation biomimetic implants, yielding an entirely new armamentarium in years to come.

Keywords

Transvaginal mesh Pelvic organ prolapse Native tissue repair 

Abbreviations

FDA

Food and Drug Administration

POP

pelvic organ prolapse

CPT

current procedural technology

PROSPERE

Prosthetic Pelvic Floor Repair

TVM

transvaginal mesh

SUI

stress urinary incontinence

Notes

Author Contribution

All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.

Compliance with Ethical Standards

Conflict of Interest

None.

Human and Animal Rights and Informed Consent

This review article does not contain any original research with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Sammarco AG, Swenson CW, Kamdar NS, Kobernik EK, DeLancey JOL, Nallamothu B, et al. Rate of pelvic organ prolapse surgery among privately insured women in the United States, 2010-2013. Obstet Gynecol. 2018;131(3):484–92.CrossRefGoogle Scholar
  2. 2.
    Younger A, Rac G, Clemens JQ, Kobashi K, Khan A, Nitti V, et al. Pelvic organ prolapse surgery in academic female pelvic medicine and reconstructive surgery urology practice in the setting of the Food and Drug Administration public health notifications. Urology. 2016;91:46–51.CrossRefGoogle Scholar
  3. 3.
    Wang LC, Al Hussein Al Awamlh B, Hu JC, Laudano MA, Davison WL, Schulster ML, et al. Trends in mesh use for pelvic organ prolapse repair from the Medicare database. Urology. 2015;86(5):885–91.CrossRefGoogle Scholar
  4. 4.
    Miller BJ, Seman EI, O'Shea RT, Hakendorf PH, Nguyen TTT. Recent trends in the management of pelvic organ prolapse in Australia and New Zealand. Aust N Z J Obstet Gynaecol. 2018.  https://doi.org/10.1007/10.111/ajo.12835.
  5. 5.
    Plata M, Bravo-Balado A, Robledo D, Castano JC, Averbeck MA, Plata MA, et al. Trends in pelvic organ prolapse management in Latin America. Neurourol Urodyn. 2018;37(3):1039–45.CrossRefGoogle Scholar
  6. 6.
    Ubertazzi EP, Soderini HFE, Saavedra Sanchez AJM, Fonseca Guzman C, Pavan LI. Long-term outcomes of transvaginal mesh (TVM) in patients with pelvic organ prolapse: a 5-year follow-up. Eur J Obstet Gynecol Reprod Biol. 2018;225:90–4.CrossRefGoogle Scholar
  7. 7.
    Chughtai B, Barber MD, Mao J, Forde JC, Normand ST, Sedrakyan A. Association between the amount of vaginal mesh used with mesh erosions and repeated surgery after repairing pelvic organ prolapse and stress urinary incontinence. JAMA Surg. 2017;152(3):257–63.CrossRefGoogle Scholar
  8. 8.
    Siddiqui NY, Edenfield AL. Clinical challenges in the management of vaginal prolapse. Int J Women's Health. 2014;6:83–94.CrossRefGoogle Scholar
  9. 9.
    Luo DY, Yang TX, Shen H. Long term follow-up of transvaginal anatomical implant of mesh in pelvic organ prolapse. Sci Rep. 2018;8(1):2829.CrossRefGoogle Scholar
  10. 10.
    Lucot JP, Cosson M, Bader G, Debodinance P, Akladios C, Salet-Lizee D, et al. Safety of vaginal mesh surgery versus laparoscopic mesh sacropexy for cystocele repair: results of the prosthetic pelvic floor repair randomized controlled trial. Eur Urol. 2018;74:167–76.CrossRefGoogle Scholar
  11. 11.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRefGoogle Scholar
  12. 12.
    Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175(1):10–7.CrossRefGoogle Scholar
  13. 13.
    Milani AL, Damoiseaux A, IntHout J, Kluivers KB, Withagen MIJ. Long-term outcome of vaginal mesh or native tissue in recurrent prolapse: a randomized controlled trial. Int Urogynecol J. 2018;29(6):847–58.CrossRefGoogle Scholar
  14. 14.
    Ow LL, Lim YN, Dwyer PL, Karmakar D, Murray C, Thomas E, et al. Native tissue repair or transvaginal mesh for recurrent vaginal prolapse: what are the long-term outcomes? Int Urogynecol J. 2016;27(9):1313–20.CrossRefGoogle Scholar
  15. 15.
    • Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Marjoribanks J. Transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse. Cochrane Database Syst Rev. 2016;2:Cd012079. Cochrane review on mesh versus native tissue repairs for POP. PubMedGoogle Scholar
  16. 16.
    Marks BK, Goldman HB. What is the gold standard for posterior vaginal wall prolapse repair: mesh or native tissue? Curr Urol Rep. 2012;13(3):216–21.CrossRefGoogle Scholar
  17. 17.
    • Mowat A, Maher D, Baessler K, Christmann-Schmid C, Haya N, Maher C. Surgery for women with posterior compartment prolapse. Cochrane Database Syst Rev. 2018;3:Cd012975. Cochrane review on posterior compartment POP repair. PubMedGoogle Scholar
  18. 18.
    • Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Brown J. Surgery for women with anterior compartment prolapse. Cochrane Database Syst Rev. 2016;11:Cd004014. Cochrane review on anterior compartment POP repair. PubMedGoogle Scholar
  19. 19.
    • Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Brown J. Surgery for women with apical vaginal prolapse. Cochrane Database Syst Rev. 2016;10:Cd012376. Cochrane review on apical compartment POP repair. PubMedGoogle Scholar
  20. 20.
    •• Mowat AE, Maher C. Transvaginal mesh: let's not repeat the mistakes of the past. Aust N Z J Obstet Gynaecol. 2017;57(1):108–10. An editorial that gives a comprehensive, efficient overview of large data sets and puts forth important considerations for surgical intervention, in the future. CrossRefGoogle Scholar
  21. 21.
    • Welk B, Carlson KV, Baverstock RJ, Steele SS, Bailly GG, Hickling DR. Canadian Urological Association position statement on the use of transvaginal mesh. Can Urol Assoc J. 2017;11(6Suppl2):S105–s7. A professional society statement that takes a stance on the use of TVM and explains its recommendations. CrossRefGoogle Scholar
  22. 22.
    Menchen LC, Wein AJ, Smith AL. An appraisal of the Food and Drug Administration warning on urogynecologic surgical mesh. Curr Urol Rep. 2012;13(3):231–9.CrossRefGoogle Scholar
  23. 23.
    Glazener CM, Breeman S, Elders A, Hemming C, Cooper KG, Freeman RM, et al. Mesh, graft, or standard repair for women having primary transvaginal anterior or posterior compartment prolapse surgery: two parallel-group, multicentre, randomised, controlled trials (PROSPECT). Lancet. 2017;389(10067):381–92.CrossRefGoogle Scholar
  24. 24.
    Weemhoff M, Vergeldt TF, Notten K, Serroyen J, Kampschoer PH, Roumen FJ. Avulsion of puborectalis muscle and other risk factors for cystocele recurrence: a 2-year follow-up study. Int Urogynecol J. 2012;23(1):65–71.CrossRefGoogle Scholar
  25. 25.
    Model AN, Shek KL, Dietz HP. Levator defects are associated with prolapse after pelvic floor surgery. Eur J Obstet Gynecol Reprod Biol. 2010;153(2):220–3.CrossRefGoogle Scholar
  26. 26.
    Dietz HP, Chantarasorn V, Shek KL. Levator avulsion is a risk factor for cystocele recurrence. Ultrasound Obstet Gynecol. 2010;36(1):76–80.CrossRefGoogle Scholar
  27. 27.
    Qatawneh A, Thekrallah F, Bata M, Al-Kazaleh F, Almustafa M, Abu-Kader I. Risk factors of surgical failure following sacrospinous colpopexy for the treatment of uterovaginal prolapse. Arch Gynecol Obstet. 2013;287(6):1159–65.CrossRefGoogle Scholar
  28. 28.
    Rodrigo N, Wong V, Shek KL, Martin A, Dietz HP. The use of 3-dimensional ultrasound of the pelvic floor to predict recurrence risk after pelvic reconstructive surgery. Aust N Z J Obstet Gynaecol. 2014;54(3):206–11.CrossRefGoogle Scholar
  29. 29.
    Vergeldt TF, Notten KJ, Weemhoff M, van Kuijk SM, Mulder FE, Beets-Tan RG, et al. Levator hiatal area as a risk factor for cystocele recurrence after surgery: a prospective study. BJOG. 2015;122(8):1130–7.CrossRefGoogle Scholar
  30. 30.
    Vergeldt TF, Weemhoff M, IntHout J, Kluivers KB. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J. 2015;26(11):1559–73.CrossRefGoogle Scholar
  31. 31.
    Dietz HP. Mesh in prolapse surgery: an imaging perspective. Ultrasound Obstet Gynecol. 2012;40(5):495–503.CrossRefGoogle Scholar
  32. 32.
    Wong V, Shek KL. The mesh debate: transvaginal anterior anchored mesh should not be abandoned. Aust N Z J Obstet Gynaecol. 2017;57(1):105–7.CrossRefGoogle Scholar
  33. 33.
    Abdul Jalil SS, Guzman Rojas R, Dietz HP. Does it matter whether levator avulsion is diagnosed pre- or postoperatively? Ultrasound Obstet Gynecol. 2016;48(4):516–9.CrossRefGoogle Scholar
  34. 34.
    Dietz HP, Lanzarone V. Levator trauma after vaginal delivery. Obstet Gynecol. 2005;106(4):707–12.CrossRefGoogle Scholar
  35. 35.
    Kearney R, Miller JM, Ashton-Miller JA, DeLancey JO. Obstetric factors associated with levator ani muscle injury after vaginal birth. Obstet Gynecol. 2006;107(1):144–9.CrossRefGoogle Scholar
  36. 36.
    Dietz HP, Shek C, De Leon J, Steensma AB. Ballooning of the levator hiatus. Ultrasound Obstet Gynecol. 2008;31(6):676–80.CrossRefGoogle Scholar
  37. 37.
    • Cundiff GW. Mesh in POP surgery should be based on the risk of the procedure, not the risk of recurrence. Int Urogynecol J. 2017;28(8):1115–8.  https://doi.org/10.1007/s00192-017-3367-7. An editorial describing use of a benefit-risk assessment to frame the discussion for patient counseling when it comes to surgical intevention for POP. CrossRefPubMedGoogle Scholar
  38. 38.
    Bissoli J, Bruschini H. Scaffolds for pelvic floor prolapse: logical pathways. Int J Biomater. 2018;2018:8040893.CrossRefGoogle Scholar
  39. 39.
    Vashaghian M, Zaat SJ, Smit TH, Roovers JP. Biomimetic implants for pelvic floor repair. Neurourol Urodyn. 2018;37(2):566–80.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Surgery, Division of Urology and Urologic OncologyCity of HopeGlendoraUSA

Personalised recommendations