I read with interest the review "Traditional Native Tissue vs Mesh-Augmented Pelvic Organ Prolapse Repairs: Providing an Accurate Interpretation of Current Literature" by Stanford et al. [1], the comment from Dietz et al. [2], and the reply by Stanford et al. [3]. Concluding that the success rate for traditional native tissue anterior repair is generally 88-97 % is certainly excessive. Some experienced pelvic surgeons think the truth is probably 70 % at 3-5 years; it is this number I use for informed consent of my patients, adding "after 10 years, I can promise nothing." The only reason I began to use anterior reinforcement mesh, 15 years ago, was this high failure rate, particularly after sacrospinous ligament fixation, and my understanding of the paravaginal defect. But to consider that posterior is more beneficial than anterior repair from a mesh-augmented repair is contrary to experience and common sense, even to the evidence-based medicine (EBM), but the authors seem to be unaware of the last Cochrane database review [4].
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