The use of mesh in gynaecological practice in the treatment of stress urinary incontinence and pelvicorgan prolapse is growing. There is anxiety and uncertainty about the long-term outcome of these interventions. This paper highlights these controversies.
In 1996, Ulmsten described the transvaginal tape (TVT) procedure and the following year, with only limited data, it was released to the market. This is a tape constructed of type-I polypropylene woven mesh. It was aggressively promoted and rapidly adopted by many gynaecologists within Europe, even though the UK and Ireland TVT Trial Group did not start recruiting patients until 1998. Fortunately, long-term follow-up studies have confirmed not only the efficacy of this procedure but also its low complication rate. Many would now consider a mid-urethral tape constructed of type-I polypro-pylene mesh to be the surgical treatment of choice in primary urodynamic stress incontinence.
Pelvic organ prolapse is a common condition affecting thousands of women worldwide and surgery rates to correct prolapse are currently increasing. Up to 300 000 women undergo surgery for pelvic organ prolapse in the USA each year. Treatment for vaginal prolapse is associated with a high recurrence rate, with the reoperation rate reported at 17% within 10 years, although even this was considered to underestimate the true rate.
The success obtained with the TVT operation and abdominal hernia surgery using mesh and the high reoperation rate for prolapse would therefore suggest the use of mesh for prolapse surgery. However, concern exists that some of the currently available mesh materials and techniques using mesh in gynaecological prolapse surgery could be associated with significant morbidity, especially if the surgeon is not familiar with the principles and properties of the individual materials. This paper reviews the current evidence in these areas.