Synthetic Meshes in Pelvic Organ Prolapse: A Narrative Review
Introduction: Pelvic organ prolapse is a common condition that can affect 50% of parous women. The surgical management can be divided into two approaches: A trans-vaginal and a trans-abdominal approach. In view of current controversies and discrepancies between guidelines, this review aims to scope...
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2025-02-01
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| Series: | Société Internationale d’Urologie Journal |
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| author | Sami Lasri Hend Alshamsi Lysanne Campeau |
| author_facet | Sami Lasri Hend Alshamsi Lysanne Campeau |
| author_sort | Sami Lasri |
| collection | DOAJ |
| description | Introduction: Pelvic organ prolapse is a common condition that can affect 50% of parous women. The surgical management can be divided into two approaches: A trans-vaginal and a trans-abdominal approach. In view of current controversies and discrepancies between guidelines, this review aims to scope the historically available data on synthetic meshes in the management of POP mainly on outcomes and complications of the trans-vaginal approach and the trans-abdominal approach. Methods: This study is a narrative review of the use of synthetic meshes in POP surgery. The different indications, the results, and comparisons to other surgical management were collected using MEDLINE and Google Scholar. Results: Regarding the trans-vaginal approach, 31 articles were included. The anatomical success rate is high, around 90%. However, this technique was recently considered cost-ineffective mostly because of high rates of erosions, ranging from 4 to 40% depending on the series. Obesity seems to be the most important risk factor of mesh erosion, followed by age and smoking. Regarding the trans-abdominal approach, 36 articles were included. In the literature, anatomical success is between 70 and 95%, with an erosion rate between 0 and 11%. Minimally invasive sacrocolpopexy and open sacrocolpopexy seem to be equally effective on anatomical outcomes and recurrence rates. Concomitant total hysterectomy might be effective but may be associated with more mesh erosions. Concomitant laparoscopic supracervical hysterectomy may be the preferred option for patients with cervical and uterine lesions but should not be performed for the sole purpose of reducing the occurrence of endometrial carcinoma, especially when uterine preservation seems effective and is associated with less blood loss and shorter operating time. Conclusion: Our review reports limited application for trans-vaginal repair because of high complications rates, leading countries to suspend their utilization. Our review reports a gold standard application for trans-abdominal sacrocolpopexy. The use of synthetic meshes in trans-abdominal sacrocolpopexy for POP repair provide durable cure rates with a lower rate of mesh-related complications and therefore may be considered the gold standard approach. |
| format | Article |
| id | doaj-art-ec883f717b8d43ecbfca4451b9178aaa |
| institution | DOAJ |
| issn | 2563-6499 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Société Internationale d’Urologie Journal |
| spelling | doaj-art-ec883f717b8d43ecbfca4451b9178aaa2025-08-20T03:21:26ZengMDPI AGSociété Internationale d’Urologie Journal2563-64992025-02-0161210.3390/siuj6010002Synthetic Meshes in Pelvic Organ Prolapse: A Narrative ReviewSami Lasri0Hend Alshamsi1Lysanne Campeau2Lady Davis Institute for Medical Research, Montreal, QC H3T 1E1, CanadaDivision of Urology, Department of Surgery, McGill University Montreal, QC H3T 1E1, CanadaLady Davis Institute for Medical Research, Montreal, QC H3T 1E1, CanadaIntroduction: Pelvic organ prolapse is a common condition that can affect 50% of parous women. The surgical management can be divided into two approaches: A trans-vaginal and a trans-abdominal approach. In view of current controversies and discrepancies between guidelines, this review aims to scope the historically available data on synthetic meshes in the management of POP mainly on outcomes and complications of the trans-vaginal approach and the trans-abdominal approach. Methods: This study is a narrative review of the use of synthetic meshes in POP surgery. The different indications, the results, and comparisons to other surgical management were collected using MEDLINE and Google Scholar. Results: Regarding the trans-vaginal approach, 31 articles were included. The anatomical success rate is high, around 90%. However, this technique was recently considered cost-ineffective mostly because of high rates of erosions, ranging from 4 to 40% depending on the series. Obesity seems to be the most important risk factor of mesh erosion, followed by age and smoking. Regarding the trans-abdominal approach, 36 articles were included. In the literature, anatomical success is between 70 and 95%, with an erosion rate between 0 and 11%. Minimally invasive sacrocolpopexy and open sacrocolpopexy seem to be equally effective on anatomical outcomes and recurrence rates. Concomitant total hysterectomy might be effective but may be associated with more mesh erosions. Concomitant laparoscopic supracervical hysterectomy may be the preferred option for patients with cervical and uterine lesions but should not be performed for the sole purpose of reducing the occurrence of endometrial carcinoma, especially when uterine preservation seems effective and is associated with less blood loss and shorter operating time. Conclusion: Our review reports limited application for trans-vaginal repair because of high complications rates, leading countries to suspend their utilization. Our review reports a gold standard application for trans-abdominal sacrocolpopexy. The use of synthetic meshes in trans-abdominal sacrocolpopexy for POP repair provide durable cure rates with a lower rate of mesh-related complications and therefore may be considered the gold standard approach.https://www.mdpi.com/2563-6499/6/1/2pelvic organ prolapsesynthetic meshestrans-vaginal approachsacrocolpopexy |
| spellingShingle | Sami Lasri Hend Alshamsi Lysanne Campeau Synthetic Meshes in Pelvic Organ Prolapse: A Narrative Review Société Internationale d’Urologie Journal pelvic organ prolapse synthetic meshes trans-vaginal approach sacrocolpopexy |
| title | Synthetic Meshes in Pelvic Organ Prolapse: A Narrative Review |
| title_full | Synthetic Meshes in Pelvic Organ Prolapse: A Narrative Review |
| title_fullStr | Synthetic Meshes in Pelvic Organ Prolapse: A Narrative Review |
| title_full_unstemmed | Synthetic Meshes in Pelvic Organ Prolapse: A Narrative Review |
| title_short | Synthetic Meshes in Pelvic Organ Prolapse: A Narrative Review |
| title_sort | synthetic meshes in pelvic organ prolapse a narrative review |
| topic | pelvic organ prolapse synthetic meshes trans-vaginal approach sacrocolpopexy |
| url | https://www.mdpi.com/2563-6499/6/1/2 |
| work_keys_str_mv | AT samilasri syntheticmeshesinpelvicorganprolapseanarrativereview AT hendalshamsi syntheticmeshesinpelvicorganprolapseanarrativereview AT lysannecampeau syntheticmeshesinpelvicorganprolapseanarrativereview |