Is There Still a Role for Transvaginal Mesh in Treatment of Pelvic Organ Prolapse?
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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.
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.
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.
KeywordsTransvaginal mesh Pelvic organ prolapse Native tissue repair
Food and Drug Administration
pelvic organ prolapse
current procedural technology
Prosthetic Pelvic Floor Repair
stress urinary incontinence
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
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.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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