Dear Dr. Petros,

We read your article regarding a novel transvaginal approach to the management of descending perineum syndrome (DPS) with great interest. Surgical treatments for this condition have not been adequately described in the literature. Certainly, some potential limitations and concerns with the approach described is the transvaginal route for the implantation of synthetic mesh in the posterior compartment—specifically relating to the risk for dyspareunia and mesh exposure. Based on your article and prior papers you have published, it appears that the amount of mesh implanted is relatively small, which should theoretically minimize these risks. The other area of variability is in the description of how the mesh is tensioned. Based on your description, it appears there is some degree of tensioning or tightening that occurs, although the original reference paper indicates that the mesh is placed in a tension-free manner. Variability in mesh tensioning will impact the reproducibility from surgeon to surgeon, which could influence postoperative complications and success rates. We look forward to additional analysis on the long-term outcomes of your patients with this challenging condition.

Dr. Chaudhry.

Dr. Tarnay.