Polypropylene Mesh for Pelvic Organ Prolapse Surgery

During the past 2 years, there has been a dramatic reduction in the employment of transvaginal mesh in the United States and simultaneously a doubling in the number of sacral colpopexies performed annually. While sacral colpopexy has strong Level 1 evidence supporting its use for posthysterectomy prolapse, the evidence supporting sacral colpopexy in those with uterine prolapse is limited. Hysterectomy performed at sacral colpopexy for uterine prolapse results in a fourfold increase in rate of mesh exposure compared with sacral colpopexy for posthysterectomy prolapse. The data supporting subtotal hysterectomy at sacral colpopexy and hysterosacropexy for uterine prolapse are Level 3 and derived from very limited numbers. With the withdrawal of commercial transvaginal polypropylene mesh products from the market, the Level 1 evidence relating to these products is derived from only 242 cases and demonstrate only an objective advantage over native tissue repairs in the anterior vaginal compartment. No Level 1 data are available to support transvaginal polypropylene mesh in multicompartment or posterior compartment vaginal prolapse.