Use of synthetic grafts in pelvic reconstruction:A path of continued discovery

摘要

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 meshassociated 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.