This courageous article addresses the growing use of mesh kits for vaginal prolapse repairs. The authors describe the seven stages in the career of surgical innovation starting with an optimistic report of early data leading to popular adoption and vigorous promotion only to be followed by appropriate analysis and abandonment, because the early claims were unfounded [1], Examples of this course are exemplified by the disastrous career of the ProteGen sling (Boston Scientific, Natick, Massachusetts, USA) and, more recently, ObTape (Mentor, Santa Barbara, California, USA). "Mesh and trocar" kits for gynaecologic surgery are now in the ascendant phase of their life cycle, although there has been no adequately powered study to suggest any advantage over traditional prolapse repairs. The authors point to a disjunction between legal permission to market a product and the prudent and ethical use of those products in clinical practice. Some proposals are suggested that might help moderate the excesses and dangers of current practice.
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