Mesh in Prolapse Surgery

  • Jay Iyer
  • Ajay Rane


Prolapse repair with synthetic mesh has become an area of debate in the last few years. The rationale for mesh use in prolapse surgery, the surgical outcomes and its complication profile will help us to understand the concerns and controversies regarding it. The lifetime risk of undergoing surgery for prolapse by age 80 is around 11 % and the reoperation rate is quoted around 29 %. The recurrence risk and the need for reoperation in nearly one-third to one-fourth of patients with prolapse surgeries means there is a need for more robust techniques in prolapse repair. Our understanding of pelvic floor anatomy changed dramatically since the description of “levels of pelvic organ support” by John DeLancey. In order to fully understand the dynamics of prolapse surgery, both native tissue and mesh repair, it is important to have a brief overview of the functional anatomy of the pelvic floor, which has been covered adequately in an earlier chapter of this textbook. Many of the treatments for pelvic organ prolapse (POP) offered today have been developed bearing in mind this renewed understanding of pelvic floor anatomy.


Pelvic Organ Prolapse Mesh Repair Anterior Compartment Prolapse Surgery Prolapse Repair 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89(4):501–6.PubMedCrossRefGoogle Scholar
  2. 2.
    DeLancey JO. Anatomy and biomechanics of genital prolapse. Clin Obstet Gynecol. 1993;36:897–909.PubMedCrossRefGoogle Scholar
  3. 3.
    Weber AM, Walters MD, Piedmonte MR, Ballard LA. Anterior colporrhaphy: a randomised trial of three surgical techniques. Am J Obstet Gynecol. 2001;185(185):1299–306.PubMedCrossRefGoogle Scholar
  4. 4.
    Kahn MA, Stanton SL, Kumar D, Fox SD. Posterior colporrhaphy is superior to the transanal repair for treatment of posterior vaginal wall prolapse. Neurourol Urodyn. 1999;18:70–1.Google Scholar
  5. 5.
    Amid PK. Classification of biomaterials and their related complications in abdominal wall hernia surgery. Hernia. 1997;1(1):15–21.CrossRefGoogle Scholar
  6. 6.
    FDA public health notification, Serious Complications Associated with Transvaginal Placement of Surgical Mesh in Repair of Pelvic Organ Prolapse and Stress Urinary Incontinence Health. Date issued: 20 October 2008.
  7. 7.
    FDA Safety Communication: UPDATE on Serious Complications Associated with Transvaginal Placement of Surgical Mesh for Pelvic Organ Prolapse. Date Issued: 13 July 2011.
  8. 8.
    National Institute of Clinical Excellence. Surgical repair of vaginal wall prolapse using mesh. United Kingdom. Published June 2008.
  9. 9.
    Muffly TM, Barber MD. Insertion and removal of vaginal mesh for pelvic organ prolapse. Clin Obstet Gynecol. 2010;53(1):99–114.CrossRefGoogle Scholar
  10. 10.
    Rane A, Frazer M, Jain A, Kannan K, Iyer J. The sacrospinous ligament conveniently effective or effectively convenient? J Obstet Gynaecol. 2011;31(5):366–70.PubMedCrossRefGoogle Scholar
  11. 11.
    Alperin M, Moalli PA. Remodeling of vaginal connective tissue in patients with prolapse. Curr Opin Obstet Gynecol. 2006;18(5):544–50.PubMedCrossRefGoogle Scholar
  12. 12.
    Kannan K, McConnell A, McLeod M, Rane A. Microscopic alterations of vaginal tissue in women with pelvic organ prolapse. J Obstet Gynaecol. 2011;31(3):250–3.PubMedCrossRefGoogle Scholar
  13. 13.
    de Tayrac R, Devoldere G, Renaudie JL, Villard P, Guilbaud O, Eblin G. 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. 2007;18:251–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Abdel-Fattah M, Ramsay I. Retrospective multicentre study of the new minimally invasive mesh repair devices for pelvic organ prolapse. BJOG. 2008;115(1):22–30.PubMedCrossRefGoogle Scholar
  15. 15.
    de Tayrac R, Gervaise AI, et al. Tension-free polypropylene mesh for vaginal repair of anterior vaginal wall prolapse. J Reprod Med. 2005;50(2):75–80.PubMedGoogle Scholar
  16. 16.
    Hiltunen R, Nieminen K, Takala T, et al. Low-weight polypropylene mesh for anterior vaginal wall prolapse: a randomized controlled trial. Obstet Gynecol. 2007;110(2 Pt 2):455–62.PubMedCrossRefGoogle Scholar
  17. 17.
    Fatton B, Amblard J, Debodinance P, Cosson M, Jacquetin B. Transvaginal repair of genital prolapse: preliminary results of a new tension-free vaginal mesh (Prolift™ technique)—a case series multicentric study. Int Urogynecol J. 2007;18(7):743–52.CrossRefGoogle Scholar
  18. 18.
    Sokol AI, Iglesia CB, Kudish BI, Gutman RE, Shveiky D, Bercik R, Sokol ER. One-year objective and functional outcomes of a randomized clinical trial of vaginal mesh for prolapse. Am J Obstet Gynecol. 2012;206(1):86–e1.PubMedCrossRefGoogle Scholar
  19. 19.
    Altman D, Väyrynen T, Engh ME, Axelsen S, Falconer C. Anterior colporrhaphy versus transvaginal mesh for pelvic-organ prolapse. N Engl J Med. 2011;364(19):1826–36.PubMedCrossRefGoogle Scholar
  20. 20.
    Carey M, Higgs P, Goh J, Lim J, Leong A, Krause H, Cornish A. Vaginal repair with mesh versus colporrhaphy for prolapse: a randomised controlled trial. BJOG. 2009;116:1380–6.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Sivaslioglu AA, Unlubilgin E, Dolen I. A randomized comparison of polypropylene mesh surgery with site-specific surgery in the treatment of cystocoele. Int Urogynecol J. 2008;19(4):467–71.CrossRefGoogle Scholar
  22. 22.
    Funk MJ, Visco AG, Weidner AC, Pate V, Wu JM. Long-term outcomes of vaginal mesh versus native tissue repair for anterior vaginal wall prolapse. Int Urogynecol J. 2013;24(8):1279–85.PubMedCentralCrossRefGoogle Scholar
  23. 23.
    Karram M, Maher C. Surgery for posterior vaginal wall prolapse. Int Urogynecol J. 2013;24(11):1835–41.PubMedCrossRefGoogle Scholar
  24. 24.
    de Tayrac R, Sentilhes L. Complications of pelvic organ prolapse surgery and methods of prevention. Int Urogynecol J. 2013;24:1859–72.PubMedCrossRefGoogle Scholar
  25. 25.
    LaSala CA, Schimpf MO. Occurrence of postoperative hematomas after prolapse repair using a mesh augmentation system. Obstet Gynecol. 2007;109:569–72.PubMedCrossRefGoogle Scholar
  26. 26.
    Wong KS, Nguyen JN, White T, Menefee SA, Walter AJ, Krulewitch CJ, Jakus-Waldman SM. Adverse events associated with pelvic organ prolapse surgeries that use implants. Obstet Gynecol. 2013;122(6):1239–45.PubMedCrossRefGoogle Scholar
  27. 27.
    Feiner B, Maher C. Vaginal mesh contraction: definition, clinical presentation, and management. Obstet Gynecol. 2010;115(2 Pt 1):325–30.PubMedCrossRefGoogle Scholar
  28. 28.
    Tijdink MM, Vierhout ME, Heesakkers JP, Withagen MIJ. Surgical management of mesh-related complications after prior pelvic floor reconstructive surgery with mesh. Int Urogynecol J. 2011;22(11):1395–404.PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    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. Int Urogynecol J. 2011;22(1):3–15.PubMedCrossRefGoogle Scholar
  30. 30.
    Araco F, Gravante G, Sorge R, et al. The influence of BMI, smoking, and age on vaginal erosions after synthetic mesh repair of pelvic organ prolapses. A multicenter study. Acta Obstet Gynecol Scand. 2009;88(7):772–80.PubMedCrossRefGoogle Scholar
  31. 31.
    Moore RD, Miklos JR. Vaginal mesh kits for pelvic organ prolapse, friend or foe: a comprehensive review. Scientific World Journal. 2009;9:163–89.PubMedCrossRefGoogle Scholar
  32. 32.
    Davila GW, Drutz H, Deprest J. Clinical implications of the biology of grafts: conclusions of the 2005 IUGA Grafts Roundtable. Int J Urogynecol Pelvic Floor Dysfunct. 2006;17 Suppl 1:51–5.CrossRefGoogle Scholar
  33. 33.
    Wall LL, Brown D. The perils of commercially driven surgical innovation. Am J Obstet Gynecol. 2010;202:30.e1–4.CrossRefGoogle Scholar
  34. 34.
    Ostergard DR. Lessons from the past: directions for the future. Do new marketed surgical procedures and grafts produce ethical, personal liability, and legal concerns for physicians? Int J Urogynecol Pelvic Floor Dysfunct. 2007;18(6):591–8.CrossRefGoogle Scholar
  35. 35.
    Ostergard DR. Vaginal mesh grafts and the Food and Drug Administration. Int Urogynecol J Pelvic Floor Dysfunct. 2010;21:1181–3.CrossRefGoogle Scholar
  36. 36.
    Jacquetin B, Cosson M. Complications of vaginal mesh: our experience. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(8):893–6.PubMedCrossRefGoogle Scholar
  37. 37.
    Skoczylas LC, Turner LC, Wang L, Winger DG, Shepherd JP. Changes in prolapse surgery trends relative to FDA notifications regarding vaginal mesh. Int Urogynecol J. 2014;25(4):471–7.PubMedCrossRefGoogle Scholar
  38. 38.
    Ellington DR, Richter HE. The role of vaginal mesh procedures in pelvic organ prolapse surgery in view of complication risk. Obstet Gynecol Int. 2013;2013:7, Article ID 356960. doi: 10.1155/2013/356960.
  39. 39.
    Nygaard I. Approval process for devices and mesh for surgical treatment of pelvic organ prolapse and urinary incontinence. Clin Obstet Gynecol. 2013;56(2):229–31.PubMedCrossRefGoogle Scholar
  40. 40.
    Rogers RG. To mesh or not to mesh: current debates in prolapse repair fueled by the U.S. Food and Drug Administration Safety Notification. Obstet Gynecol. 2011;118(4):771–3.PubMedCrossRefGoogle Scholar
  41. 41.
    Maher CF, Feiner B, DeCuyper EM, Nichlos CJ, Hickey KV, O’Rourke PV. Laparoscopic sacral colpopexy versus total vaginal mesh for vaginal vault prolapse: a randomized trial. Am J Obstet Gynecol. 2011;204:360–7.PubMedCrossRefGoogle Scholar
  42. 42.
    Withagen M, Milani AL, den Boom J, Vervest HA, Vierhout ME. Trocar-guided mesh compared with conventional vaginal repair in recurrent prolapse: a randomized controlled trial. Obstet Gynecol. 2011;117:242–50.PubMedCrossRefGoogle Scholar
  43. 43.
    Maher C, Feiner B, Baessler K, Schmid C. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013;(4). Art. No.:CD004014. doi: 10.1002/14651858.CD004014.pub5.
  44. 44.
    Maher C, Baessler K, Barber M, Cheon C, Deitz V, DeTayrac R, Gutman R, Karram M, Sentilhes L. Chapter 15. Surgical management of pelvic organ prolapse. In: Abrams C, Khoury W, editors. 5th international consultation on incontinence. Paris: Health Publication Ltd; 2013.Google Scholar

Copyright information

© Springer India 2015

Authors and Affiliations

  1. 1.Department of Obstetrics and GynaecologyJames Cook UniversityTownsvilleAustralia

Personalised recommendations