Pelvic organ prolapse (POP) is a highly prevalent condition. Many effective treatments exist for this condition, including pelvic floor exercises, support devices such as pessaries, and surgery. Surgical techniques have evolved over time in an effort to treat POP in an effective, safe, and durable manner. Synthetic mesh has been utilized by many surgeons as an adjunctive technique to improve the long term results of surgical repair.
Like all surgical techniques, the incorporation of mesh into surgical POP repair has potential advantages and disadvantages. Mesh may improve long term anatomic results of surgery as compared to non-mesh repairs for some types of prolapse. Certain patients may benefit from mesh techniques, and the use of mesh techniques should be a choice that is made after a careful discussion between surgeon and patient. Better data are needed to determine the appropriate role of vaginal mesh techniques in the treatment of POP.
Vaginal mesh placement for POP is associated with risks to the patient including vaginal extrusion, erosion, sexual dysfunction, urinary tract injury, pain and other complications. Like with all surgeries, these complications may be due to surgical technique, the materials utilized, patient anatomy, or a combination of factors. It is also important to recognize that many of these complications are not unique to mesh surgeries and are known to occur with non-mesh POP procedures as well. In patients with postoperative symptoms that are not clearly caused by a mesh complication, removal of vaginal mesh may not improve the symptoms, and in fact may worsen their condition.
Many women undergo mesh POP repairs without complications. There is no convincing evidence that vaginal mesh placement can cause an autoimmune response, and there is no reason to remove vaginal mesh in asymptomatic patients. In patients who have had vaginal mesh surgery for pelvic organ prolapse and are satisfied with their results, there is no need to take any action other than routine check-ups and follow-up care.
Vaginal mesh can be used for the surgical treatment of stress urinary incontinence (SUI) or POP. The AUA believes that it is critically important to distinguish between these two uses of vaginal mesh. Extensive data exist to support the use of contemporary synthetic mesh slings to treat SUI, with minimal morbidity compared with alternative surgical techniques. Mesh-related complications from sling placement are typically easier to address than those related to POP repair. The AUA Guideline for the Surgical Management of Stress Urinary Incontinence (2009) concluded that synthetic slings are an appropriate treatment for women with stress incontinence, with similar efficacy but less morbidity than conventional non-mesh sling techniques.
The AUA strongly agrees with the FDA1 that a thorough informed consent should be conducted prior to the use of mesh products for pelvic organ prolapse. The AUA also agrees with the FDA statement that surgeons who wish to utilize mesh techniques for pelvic organ prolapse should:
- Undergo rigorous training in the principles of pelvic anatomy and pelvic surgery.
- Be properly trained in specific mesh implantation techniques.
- Be able to recognize and manage complications associated with vaginal mesh.
Board of Directors, November 2011
Board of Directors, October 2016 (Reaffirmed)