Vaginal mesh update.

PURPOSE OF REVIEW: As more women undergo repairs of pelvic organ prolapse (POP), an ever-increasing scrutiny has been placed on repairs utilizing vaginal mesh. We aim to review the current literature regarding mesh POP repairs and discuss the Food and Drug Administration controversy.

RECENT FINDINGS: Evidence-based literature indicates that the objective success of standard (plication-type) repairs in the anterior compartment may not be durable, and that augmentation with nonabsorbable, synthetic mesh may be superior. Augmentation in the posterior compartment may not present a clear advantage over standard repair. Transvaginal mesh used for POP repair may be associated with adverse sequelae, such as erosion, extrusion, and infection. Additionally, there is concern regarding potential long-term outcomes such as dyspareunia, chronic pelvic pain, and vaginal distortion, which may occur even in the absence of frank extrusion. Recent warnings by the Food and Drug Administration regarding adverse events after transvaginal mesh implantation have led to a call for an increase in the premarket testing and postmarket surveillance of these products.

SUMMARY: Although the use of transvaginal mesh may improve anatomical outcomes over standard repairs, the subjective improvement may be similar. Furthermore, the recent warnings regarding mesh placement may lead to a greater level of regulation of these products.