Pros and cons of new mesh repair devices for pelvic organ prolapse

Article

While new minimally invasive mesh repair devices for pelvic organ prolapse seem to offer high short-term cure rates (94%-100%) and low morbidity rates, the severity of some of the complications led the authors of a recent retrospective multicenter study performed in Scotland to call for additional rigorous evaluation of these devices and prompted the editors of the journal in which the study was published to remind readers that the possibility of such consequences needs to be part of fully informed consent.

While new minimally invasive mesh repair devices for pelvic organ prolapse seem to offer high short-term cure rates (94%-100%) and low morbidity rates, the severity of some of the complications led the authors of a recent retrospective multicenter study performed in Scotland to call for additional rigorous evaluation of these devices and prompted the editors of the journal in which the study was published to remind readers that the possibility of such consequences needs to be part of fully informed consent.

The study included 289 women undergoing surgical management of genital tract prolapse with either Gynecare or American Medical Systems prolapse repair mesh devices during the period from January 2005 to December 2006. Complications requiring surgery included bladder injury (1.6%), rectal injury (1.1%), and two women with serious vascular injuries. In terms of postoperative complications, one in 10 women had mesh eroding into their vagina, one in 20 women had buttock pain (5.2%), one woman had bladder erosion, and two women developed serious infections, which lead to necrotizing fasciitis in one of them. Five percent of the women had persistent prolapse at 3 months' follow-up.

Abdel-fattah M, Ramsay I, West of Scotland Study Group. Retrospective multicenter study of the new minimally invasive mesh repair devices for pelvic organ prolapse. BJOG. 2008;115:22-30.

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