Taiwanese Journal of Obstetrics and Gynecology
Volume 47, Issue 2 , Pages 151-156, June 2008

The Use of Prostheses in Pelvic Reconstructive Surgery: Joy or Toy?

  • Ming-Ping Wu

      Affiliations

    • Division of Urogynecology and Pelvic Floor Reconstruction, Department of Obstetrics and Gynecology, Chi Mei Foundation Hospital, Tainan, Taiwan
    • Department of Obstetrics and Gynecology, College of Medicine, Taipei Medical University, Taipei, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr Ming-Ping Wu, Division of Urogynecology and Pelvic Floor Reconstruction, Department of Obstetrics and Gynecology, Chi Mei Foundation Hospital, 901, Chung Hwa Road, Yung Kang City, Tainan, Taiwan

Accepted 4 January 2008.

Article Outline

Summary 

The high recurrence rate of pelvic organ prolapse (POP) of up to 30% after pelvic reconstructive surgery makes a more refined surgery imperative, as well as the need for either biological or synthetic prostheses as adjuvant treatment. Patients with recurrence risks may benefit from the adjuvant treatment: (1) to substitute for the lack of supportive tissue; (2) to reinforce inadequate tissue; (3) to induce new supportive tissue; and (4) to consolidate and complement the insufficient surgical techniques. However, some debatable issues in use of the prosthetics remain. The use of prosthetics enables the simultaneous repair of all vaginal defects of POP and concomitant anti-incontinence surgery to be faster, easier and more precise. Nevertheless, great care should be devoted to the actual and theoretical short- and long-term risks, many of which have not been fully elucidated. Despite the lack of various ideal characteristics, the type I monofilament, macroporous polypropylene, has been suggested to have the lowest incidence of infection and erosion among the nonabsorbable prostheses. There is good evidence to support the use of nonabsorbable synthetic mesh for abdominal sacrocolpopexy, while the use of prostheses for repairing isolated anterior and posterior compartment defects remains controversial. There have been no long-term studies with sufficient patient numbers to prove whether synthetic or biological prostheses are superior during vaginal surgery. Tension-free vaginal mesh techniques with procedural kits are being adopted increasingly, despite the paucity of data. Although short-term follow-up studies have shown tension-free vaginal mesh to be a safe and effective technique to correct POP, anatomic and functional results of long-term follow-up studies, however, have not yet confirmed the effectiveness and safety. Mesh erosion remains a concern, with variable rates according to different materials and approaches. Newly developed prostheses offer an alternative option to pelvic reconstructive surgery. However, some questions remain: (1) Should prostheses be considered for primary repairs, secondary repairs, or solely in patients with risk factors for recurrence? (2) Which prosthetic material is better: synthetic or biological ones; absorbable or nonabsorbable ones? (3) Do the benefits of prosthetics in pelvic reconstructive surgery outweigh the risks of complications? These questions are explored and reports in the literature reviewed. [Taiwan J Obstet Cynecol 2008;47(2):151-156]

Key Words:  pelvic organ prolapse , pelvic reconstructive surgery , prosthesis , tension-free vaginal mesh

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Olsen AL , Smith VJ , Bergstrom JO , Colling JC , Clark AL . Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence . Obstet Gynecol . 1997;89:501–506
  2. Whitesides JL , Weber AM , Meyn LA , Walters MD . Risk factors for prolapse recurrence after vaginal repair . Am J Obstet Gynecol . 2004;191:1533–1538
  3. Whitesides JL , Weber AM , Meyn LA , Walters MD . Risk factors for prolapse recurrence after vaginal repair . Obstet Gynecol Surv . 2005;60:164–165
  4. Birch C , Fynes MM . The role of synthetic and biological prostheses in reconstructive pelvic floor surgery . Curr Opin Obstet Gynecol . 2002;14:527–535
  5. Baessler K , Maher CF . Mesh augmentation during pelvicfloor reconstructive surgery: risks and benefits . Curr Opin Obstet Gynecol . 2006;18:560–566
  6. DeLancey JO . Anatomic aspects of vaginal eversion after hysterectomy . Am J Obstet Gynecol . 1992;166:1717–1724 discussion 1724–8.
  7. Kobashi KC , Mee SL , Leach GE . A new technique for cystocele repair and transvaginal sling: the cadaveric prolapse repair and sling (CAPS) . Urology . 2000;56(6 Suppl 1):9–14
  8. Ng CC , Chong CY . The effectiveness of transvaginal anterior colporrhaphy reinforced with polypropylene mesh in the treatment of severe cystoceles . Ann Acad Med Singapore . 2006;35:875–881
  9. Birch C . The use of prosthetics in pelvic reconstructive surgery . Best Pract Res Clin Obstet Gynaecol . 2005;19:979–991
  10. Luijendijk RW , Hop WC , van den Tol MP , et al.   A comparison of suture repair with mesh repair for incisional hernia . N Engl J Med . 2000;343:392–398
  11. Karlovsky ME , Kushner L , Badlani GH . Synthetic biomaterials for pelvic floor reconstruction . Curr Urol Rep . 2005;6:376–384
  12. Cosson M, Debodinance P, Boukerrou M, Chauvet MP, Lobry P, Crépin G, et al. Mechanical properties of synthetic implants used in the repair of prolapse and urinary incontinence in women: which is the ideal material? . Int Urogynecol J Pelvic Floor Dysfunct . 2003;14:169–178
  13. Amid PK . Classification of biomaterials and their related complications in abdominal wall hernia surgery . Hernia . 1997;1:15–21
  14. Mostow EN , Haraway GD , Dalsing M , Hodde JP , King D . Effectiveness of an extracellular matrix graft (OASIS Wound Matrix) in the treatment of chronic leg ulcers: a randomized clinical trial . J Vasc Surg . 2005;41:837–843
  15. Winters JC , Fitzgerald MP , Barber MD . The use of synthetic mesh in female pelvic reconstructive surgery . BJU Int . 2006;98(Suppl 1):70–76 discussion 77.
  16. Lane FE . Repair of posthysterectomy vaginal-vault prolapse . Obstet Gynecol . 1962;20:72–77
  17. Nygaard IE , McCreery R , Brubaker L , et al.   Abdominal sacrocolpopexy: a comprehensive review . Obstet Gynecol . 2004;104:805–823
  18. Culligan PJ , Blackwell L , Goldsmith LJ , Graham CA , Rogers A , Heit MH . A randomized controlled trial comparing fascia lata and synthetic mesh for sacral colpopexy . Obstet Gynecol . 2005;106:29–37
  19. Fitzgerald MP , Edwards SR , Fenner D . Medium-term followup on use of freeze-dried, irradiated donor fascia for sacrocolpopexy and sling procedures . Int Urogynecol J Pelvic Floor Dysfunct . 2004;15:238–242
  20. Julian TM . The efficacy of Marlex mesh in the repair of severe, recurrent vaginal prolapse of the anterior midvaginal wall . Am J Obstet Gynecol . 1996;175:1472–1475
  21. Flood CG , Drutz HP , Waja L . Anterior colporrhaphy reinforced with Marlex mesh for the treatment of cystoceles . Int Urogynecol J Pelvic Floor Dysfunct . 1998;9:200–204
  22. Dwyer PL , O'Reilly BA . Transvaginal repair of anterior and posterior compartment prolapse with Atrium polypropylene mesh . BJOG . 2004;111:831–836
  23. de Tayrac R , Gervaise A , Chauveaud A , Fernandez H . Tensionfree polypropylene mesh for vaginal repair of anterior vaginal wall prolapse . J Reprod Med . 2005;50:75–80
  24. Salvatore S , Soligo M , Meschia M . Prosthetic surgery for genital prolapse functional outcome . Neurourol Urodyn . 2002;21:296–297
  25. Milani R , Salvatore S , Soligo M , Pifarotti P , Meschia M , Cortese M . Functional and anatomical outcome of anterior and posterior vaginal prolapse repair with prolene mesh . BJOG . 2005;112:107–111
  26. Deffieux X , de Tayrac R , Huel C , et al.   Vaginal mesh erosion after transvaginal repair of cystocele using Gynemesh or Gynemesh-Soft in 138 women: a comparative study . Int Urogynecol J Pelvic Floor Dysfunct . 2007;18:73–79
  27. Sand PK, Koduri S, Lobel RW, Winkler HA, Tomezsko J, Culligan PJ, et al. Prospective randomized trial of polyglactin 910 mesh to prevent recurrence of cystoceles and rectoceles . Am J Obstet Gynecol . 2001;184:1357–1362 discussion 1362–4.
  28. Weber AM , Walters MD , Piedmonte MR , Ballard LA . Anterior colporrhaphy: a randomized trial of three surgical techniques . Am J Obstet Gynecol . 2001;185:1299–1304 discussion 1304–6.
  29. 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 Pelvic Floor Dysfunct . 2007;18:743–752
  30. Visco AG, Weidner AC, Barber MD, Myers ER, Cundiff GW, Bump RC, et al. Vaginal mesh erosion after abdominal sacral colpopexy . Am J Obstet Gynecol . 2001;184:297–302
  31. Debodinance P , Cosson M , Burlet G . Tolerance of synthetic tissues in touch with vaginal scars: review to the point of 287 cases . Eur J Obstet Gynecol Reprod Biol . 1999;87:23–30
  32. Siegel AL , Kim M , Goldstein M , Levey S , Ilbeigi P . High incidence of vaginal mesh extrusion using the intravaginal slingplasty sling . J Urol . 2005;174:1308–1311
  33. Debodinance P , Berrocal J , Clave H , et al.   Changing attitudes on the surgical treatment of urogenital prolapse: birth of the tension-free vaginal mesh . J Gynecol Obstet Biol Reprod (Paris) . 2004;33:577–588 [In French]

PII: S1028-4559(08)60072-8

doi:10.1016/S1028-4559(08)60072-8

Taiwanese Journal of Obstetrics and Gynecology
Volume 47, Issue 2 , Pages 151-156, June 2008

Article Tools