Current Urology Reports

, Volume 13, Issue 3, pp 222–230 | Cite as

Central Compartment and Apical Defect Repair Using Synthetic Mesh

  • Karen Soules
  • J. Christian Winters
  • Christopher J. Chermansky
Female Urology (A Gousse, Section editor)


Pelvic organ prolapse is an increasingly common condition for women that has been challenging to treat due to high recurrence rates after surgical repair. The introduction of mesh-augmented prolapse repairs as a means to achieve more robust repairs had great initial promise. As more data emerge on outcomes and novel mesh complications, the when and where of mesh augmentation has become much less clear. This article reviews the relevant literature on the use of mesh in central and apical repairs. This includes a detailed look at the available data for vaginal mesh kits and several recent trials comparing mesh kits to traditional repairs. The article ends with a discussion of the recent U.S. Food and Drug Administration (FDA) safety communication on the use of transvaginal mesh in pelvic organ prolapse and the authors’ views of how practice may change in this new environment.


Mesh Pelvic organ prolapse Stress urinary incontinence Anterior sacrocolpopexy Randomized controlled trials FDA Anterior colporrhaphy Quality of life Female urology 



K. Soules: none. Dr. J. Christian Winters has served as a consultant for Astellas and Pfizer. Dr. Christopher J. Chermansky has served as a consultant and on the speakers bureaus for Astellas and Allergan; and was a trial investigator on behalf of Contura.


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

  1. 1.
    Olsen A, Smith V, Bergstrom J, et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89:501–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Wu JM, Hundley AF, Fulton RG, et al. Forecasting the prevalence of pelvic floor disorders in U.S. women: 2010 to 2050. Obstet Gynecol. 2009;114:1278–83.PubMedCrossRefGoogle Scholar
  3. 3.
    Burger JQ, Luijendijk RW, Hop WC, et al. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg. 2004;240:578–83.PubMedGoogle Scholar
  4. 4.
    •• FDA Safety Communication: UPDATE on serious complications associated with transvaginal placement of surgical mesh for pelvic organ prolapse (2011) The recent FDA safety communication addresses the concerns that many practitioners and patients have regarding mesh complications.
  5. 5.
    FDA public health notification: Serious complications associated with transvaginal placement of surgical mesh in repair of pelvic organ prolapse and stress urinary incontinence (2008)
  6. 6.
    •• Haylen BT, Freeman RM, Swift SE, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prostheses (meshes, implants, tapes) and grafts in female pelvic floor surgery. Neurourol Urodyn. 2011;30:2–12. This detailed article provides a new classification system for reporting mesh complications. PubMedCrossRefGoogle Scholar
  7. 7.
    Maher CF, Qatawneh AM, Dwyer PL, et al. Abdominal sacrocolpopexy or vaginal sacrospinous colpopexy for vaginal vault prolapse: a prospective randomized study. Am J Obstet Gynecol. 2004;190:20–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Maher C, Feiner B, Baessler K, et al. Surgical management of pelvic organ prolapsed in women. Cochrane Database Syst Rev. 2010;14:CD004014.Google Scholar
  9. 9.
    Benson JT, Lucente V, McClellan E. Vaginal versus abdominal reconstructive surgery for the treatment of pelvic support defects: a prospective randomized study with long-term outcome evaluation. Am J Obstet Gynecol. 1996;175:1418–21.PubMedCrossRefGoogle Scholar
  10. 10.
    Lo TS, Wang AC. Abdominal colposacropexy and sacrospinous ligament suspension for severe uterovaginal prolapse: a comparison. J Gynecol Surg. 1998;14:59–64.CrossRefGoogle Scholar
  11. 11.
    Nygaard IE, McCreery R, Brubaker L, et al. Abdominal sacrocolpopexy: a comprehensive review. Obstet Gynecol. 2004;104:805–23.PubMedCrossRefGoogle Scholar
  12. 12.
    Blanchard KA, Vanlangendonck R, Winters JC. Recurrent pelvic floor defects after abdominal sacral colpopexy. J Urol. 2006;175:1010–3.PubMedCrossRefGoogle Scholar
  13. 13.
    Cundiff GW, Harris RL, Coates K, et al. Abdominal sacral colpoperineopexy: a new approach for correction of posterior compartment defects and perineal descent associated with vaginal vault prolapse. Am J Obstet Gynecol. 1997;177:1345–53.PubMedCrossRefGoogle Scholar
  14. 14.
    Higgs PJ, Chua HL, Smith AR. Long term review of laparoscopic sacrocolpopexy. BJOG. 2005;112:1134–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Rozet F, Mandron E, Arroyo C, et al. Laparoscopic sacral colpopexy approach for genito-urinary prolapse: experience with 363 cases. Eur Urol. 2005;47:230–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Ross JW, Preston M. Laparoscopic sacrocolpopexy for severe vaginal vault prolapse: five year outcome. J Minim Invasive Gynecol. 2005;12:221–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Hsiao KC, Latchamsetty K, Govier FE, et al. Comparison of laparoscopic and abdominal sacrocolpopexy for the treatment of vaginal vault prolapse. J Endourol. 2007;21:926–30.PubMedCrossRefGoogle Scholar
  18. 18.
    Klauschie JL, Suozzi BA, O’Brien MM, et al. A comparison of laparoscopic and abdominal sacral colpopexy: objective outcome and perioperative differences. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20:273–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Geller EJ, Siddiqui NY, Wu JM, et al. Short-term outcomes of robotic sacrocolpopexy compared with abdominal sacrocolpopexy. Obstet Gynecol. 2008;112:1201–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Elliott DS, Krambeck AE, Chow GK. Long-term results of robotic assisted laparoscopic sacrocolpopexy for the treatment of high grade vaginal vault prolapse. J Urol. 2006;176:655–9.PubMedCrossRefGoogle Scholar
  21. 21.
    • Paraiso MF, Jelovsek JE, Frick A, et al. Laparoscopic compared with robotic sacrocolpopexy for vaginal prolapse: a randomized controlled trial. Obstet Gynecol. 2011;Nov;118:1005–13. This randomized controlled trial compares laparoscopic and robotic sacrocolpopexy and addresses cost comparison. Google Scholar
  22. 22.
    Elliott CS, Hsieh MH, Sokol ER, et al. Robot-assisted versus open sacrocolpopexy: a cost-minimization analysis. J Urol. 2012;187:638–43.PubMedCrossRefGoogle Scholar
  23. 23.
    Stepanian AA, Miklos JR, Moore RD, et al. Risk of mesh extrusions and other mesh-related complications after laparoscopic sacral colpopexy with or without concurrent laparoscopic-assisted vaginal hysterectomy: experience of 402 patients. J Minim Invasive Gynecol. 2008;15:188–96.PubMedCrossRefGoogle Scholar
  24. 24.
    Tan-Kim J, Menefee SA, Luber KM, et al. Prevalence and risk factors for mesh erosion after laparoscopic-assisted sacrocolpopexy. Int Urogynecol J. 2011;22:205–12.PubMedCrossRefGoogle Scholar
  25. 25.
    Rodriguez LV, Bukkapatnam R, Shah SM, et al. Transvaginal paravaginal repair of high-grade cystocele central and lateral defects with concomitant suburethral sling: report of early results, outcomes, and patient satisfaction with a new technique. Urology. 2005;66:57–65.PubMedCrossRefGoogle Scholar
  26. 26.
    de Tayrac R, Deffieux X, Gervaise A, et al. Long-term anatomical and functional assessment of trans-vaginal cystocele repair using a tension-free polypropylene mesh. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17:483–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Mourtialon P, Letouzey V, Eglin G, et al. Cystocele repair by vaginal route: comparison of three different surgical techniques of mesh placement. Int Urogynecol J. 2012;Jan 17 [Epub].Google Scholar
  28. 28.
    Walter JE, Urogynaecology Committee, Lovatsis D, et al. Transvaginal mesh procedures for pelvic organ prolapse. J Obstet Gynaecol Can. 2011;33:168–74.PubMedGoogle Scholar
  29. 29.
    van Raalte HM, Lucente VR, Molden SM, et al. One-year anatomic and quality of life outcomes after the Prolift procedure for treatment of posthysterectomy prolapse. Am J Obstet Gynecol. 2008;199:694.e1–694e6.CrossRefGoogle Scholar
  30. 30.
    Elmer C, Altman D, Engh ME, et al. Trocar-guided transvaginal mesh repair of pelvic organ prolapse. Obstet Gynecol. 2009;113:117–26.PubMedGoogle Scholar
  31. 31.
    Jacquetin B, Fatton B, Rosenthal C, et al. Total transvaginal mesh (TVM) technique for treatment of pelvic organ prolapse: a 3-year prospective follow-up study. Int Urogynecol J. 2010;21:1455–62.PubMedCrossRefGoogle Scholar
  32. 32.
    Gauruder-Burmester A, Koutouzidou P, Rohne J, et al. Follow-up after polypropylene mesh repair of anterior and posterior compartments in patients with recurrent prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:1059–64.PubMedCrossRefGoogle Scholar
  33. 33.
    Moore RD, Beyer RD, Jacoby K, et al. 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. 2010;21:545–52.PubMedCrossRefGoogle Scholar
  34. 34.
    Rane A, Iyer J, Kannan K, et al. Prospective study of the Perigee system for treatment of cystocele—our five-year experience. Aust N Z J Obstet Gynaecol. 2012;52:28–33.PubMedCrossRefGoogle Scholar
  35. 35.
    Culligan PJ, Littman PM, Salamon CG, et al. Evaluation of a transvaginal mesh delivery system for the correction of pelvic organ prolapse: subjective and objective findings at least 1 year after surgery. Am J Obstet Gynecol. 2010;203:506e1–6.CrossRefGoogle Scholar
  36. 36.
    Moore RD, Mitchell GK, Miklos JR. Single-incision vaginal approach to treat cystocele and vault prolapse with an anterior all mesh anchored apically to the sacrospinous ligaments. Int Urogynecol J. 2012;23:85–91.PubMedCrossRefGoogle Scholar
  37. 37.
    Zyczynski HM, Carey MP, Smith AR, et al. One-year clinical outcomes after prolapse surgery with nonanchored mesh and vaginal support device. Am J Obstet Gynecol. 2010;203:587.e1–8.CrossRefGoogle Scholar
  38. 38.
    • Nguyen JN, Jakus-Waldman SM, Walter AJ, et al. Perioperative complications and reoperations after incontinence and prolapse surgeries using prosthetic implants. Obstet Gynecol. 2012;119:539–46. This analysis of a large group of patients looks at rates of mesh complications and reoperation. PubMedCrossRefGoogle Scholar
  39. 39.
    •• Maher CM, Feiner B, Baessler K, et al. Surgical management of pelvic organ prolapse in women: the updated summary version Cochrane review. Int Urogynecol J. 2011;22:1445–57. This excellent, updated review summarizes 40 trials on surgery for pelvic organ prolapse. PubMedCrossRefGoogle Scholar
  40. 40.
    Kaufman Y, Singh SS, Alturki H, et al. Age and sexual activity are risk factors for mesh exposure following transvaginal mesh repair. Int Urogynecol J. 2011;22:307–13.PubMedCrossRefGoogle Scholar
  41. 41.
    Withagen MI, Vierhout ME, Hendriks JC, et al. Risk factors for exposure, pain, and dyspareunia after tension-free vaginal mesh procedure. Obstet Gynecol. 2011;118:629–36.PubMedCrossRefGoogle Scholar
  42. 42.
    Latthe PM, Singh P, Foon R, et al. Two routes of transobturator tape procedures in stress urinary incontinence: a meta-analysis with direct and indirect comparison of randomized trials. BJU Int. 2010;106:68–76.PubMedCrossRefGoogle Scholar
  43. 43.
    Milani AL, Withagen MI, The HS, et al. Sexual function following trocar-guided mesh or vaginal native tissue repair in recurrent prolapse: a randomized controlled trial. J Sex Med. 2011;8:2944–53.PubMedCrossRefGoogle Scholar
  44. 44.
    Wang CL, Long CY, Juan YS, et al. Impact of total vaginal mesh surgery for pelvic organ prolapse on female sexual function. Int J Gynaecol Obstet. 2011;115:167–70.PubMedCrossRefGoogle Scholar
  45. 45.
    Nguyen JN, Burchette RM. Outcome after anterior vaginal prolapse repair: a randomized controlled trial. Obstet Gynecol. 2008;111:891–8.PubMedCrossRefGoogle Scholar
  46. 46.
    Altman D, Väyrynen T, Engh ME, et al. Short-term outcome after transvaginal mesh repair of pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:787–93.PubMedCrossRefGoogle Scholar
  47. 47.
    •• Altman D, Väyrynen T, Engh ME, et al. Anterior colporrhaphy versus transvaginal mesh for pelvic organ prolapse. N Engl J Med. 2011;363:1826–36. This is the largest multicenter randomized controlled trial with 1-year follow-up published to date comparing traditional anterior colporrhaphy with a transvaginal mesh procedure. CrossRefGoogle Scholar
  48. 48.
    Vollebregt A, Fischer K, Gietelink D, et al. Primary surgical repair of anterior vaginal prolapse: a randomised trial comparing anatomical and functional outcome between anterior colporrhaphy and trocar-guided transobturator anterior mesh. BJOG. 2011;118:1518–27.PubMedCrossRefGoogle Scholar
  49. 49.
    Nieminen K, Hiltunen R, Takala T, et al. Outcomes after anterior vaginal wall repair with mesh: a randomized, controlled trial with a 3 year follow-up. Am J Obstet Gynecol. 2010;203:235.e1–8.CrossRefGoogle Scholar
  50. 50.
    Sokol AI, Iglesia CB, Kudish BI, et al. One-year objective and functional outcomes of a randomized clinical trial of vaginal mesh for prolapse. Am J Obstet Gynecol. 2012;206:86.e1–9.CrossRefGoogle Scholar
  51. 51.
    • Withagen MI, Milani AL, de Leeuw JW, et al. Development of de novo prolapse in untreated vaginal compartments after prolapse repair with and without mesh: a secondary analysis of a randomised controlled trial. BJOG. 2012;119:354–60. This analysis of a randomized controlled trial looks at the development of prolapse in untreated compartments after mesh-augmented prolapse repairs. PubMedCrossRefGoogle Scholar
  52. 52.
    •• Maher CF, Feiner B, DeCuyper EM, et al. Laparoscopic sacral colpopexy versus total vaginal mesh for vaginal vault prolapse: a randomized trial. Am J Obstet Gynecol. 2011;204:360.e1-360.e7. This is the first randomized controlled trial comparing sacrocolpopexy and transvaginal mesh. CrossRefGoogle Scholar
  53. 53.
    Murphy M, Holzberg A, van Raalte, et al. Time to rethink: an evidence-based response from pelvic surgeons to the FDA Safety Communication: “UPDATE on serious complications associated with transvaginal placement of mesh for pelvic organ prolapse”. Int Urogynecol J. 2012;23:5–9.PubMedCrossRefGoogle Scholar
  54. 54.
    Abed H, Rahn D, Lowenstein L, et al. Incidence and management of graft erosion, wound granulation, and dyspareunia following vaginal prolapse repair with graft materials: a systematic review. Int Urogynecol J. 2011;22:789–98.PubMedCrossRefGoogle Scholar
  55. 55.
    Urogynecologic surgical mesh: Update on the safety and effectiveness of transvaginal placement for pelvic organ prolapse (2011).
  56. 56.
    Vaiyapuri GR, Han HC, Lee LC, et al. Use of the Gynecare Prolift system in surgery for pelvic organ prolapse: 1-year outcome. Int Urogynecolo J. 2011;22:869–77.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Karen Soules
    • 1
  • J. Christian Winters
    • 1
  • Christopher J. Chermansky
    • 1
  1. 1.Department of UrologyLouisiana State University Health Sciences Center New OrleansNew OrleansUSA

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