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World J Clin Urol. Mar 24, 2016; 5(1): 11-17
Published online Mar 24, 2016. doi: 10.5410/wjcu.v5.i1.11
Use of synthetic grafts in pelvic reconstruction: A path of continued discovery
Seth A Cohen, Shlomo Raz
Seth A Cohen, Shlomo Raz, Division of Pelvic Medicine and Reconstructive Surgery, Department of Urology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-7366, United States
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Shlomo Raz, MD, Professor of Urology, Chief (Division of Pelvic Medicine and Reconstructive Surgery), Director (Fellowship Program in Pelvic Medicine and Reconstructive Surgery), Division of Pelvic Medicine and Reconstructive Surgery, Department of Urology, UCLA Medical Center, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Suite 140, Los Angeles, CA 90095-7366, United States. sraz@mednet.ucla.edu
Telephone: +1-310-7940206 Fax: +1-310-7940211
Received: November 12, 2015
Peer-review started: November 16, 2015
First decision: December 7, 2015
Revised: January 20, 2016
Accepted: February 14, 2016
Article in press: February 16, 2016
Published online: March 24, 2016
Processing time: 126 Days and 18 Hours
Abstract

Since the 1990s, mesh has been used in pelvic reconstruction to augment repairs for stress urinary incontinence and pelvic organ prolapse (POP). In 2008 and 2011, the United States Food and Drug Administration (FDA) issued Public Health Notifications ultimately informing providers and the public that complications associated with the use of synthetic mesh in the transvaginal repair of POP are not rare. In this review, we (1) examine literature characterizing surgical practice-patterns subsequent to the FDA announcements; (2) describe presentation of mesh-associated complications and outcomes of management; (3) discuss the most recent materials science research; and (4) seek to characterize whether or not mesh has lived up to the long-term efficacy promise of a permanent implant. Durability of mesh-augmented anatomical outcomes do not consistently translate into improved patient satisfaction and subjective outcomes. This, when coupled with the possibility of mesh-associated complications, emphasizes the need for continued innovation beyond the status quo of current synthetic grafts.

Keywords: Pelvic organ prolapse; Mesh; Synthetic graft; Mesh-associated complications; Mesh extrusion; Mesh erosion; Host response

Core tip: While mesh-augmented prolapse repair would appear to improve anatomical outcomes, it does not consistently translate into improved patient satisfaction. The use of mesh implantation has to be balanced with the added morbidity of possible delayed mesh-associated complications over-time. We simply seek to recognize that there will be women who will suffer from adverse outcomes after these implants (just as there can be complications after any type of surgery); it is important to recognize the need and possible benefit of effective intervention, all the while continuing to challenge ourselves to improve the techniques and materials we use in pelvic reconstruction.