OBJECTIVES: Pelvic floor diseases (PFDS) such as stress urinary incontinence (SUI) and pelvic organ prolapse (POP) are common and vexing disorders.
While synthetic mesh based repairs have long been considered an option for PFD treatment, and their efficacy established in RCT trials, safety of its use has recently been called into question. In order to better understand this controversy we reviewed the scientific and clinical literature to assess the basis for its use.
MATERIALS AND METHODS: Using the PubMed, MEDLINE and MeSH databases, we performed a critical review of English-language publications that contained the following keywords: pelvic organ prolapse, stress urinary incontinence, mesh, biomaterial, collagen, elastin and extracellular matrix. After reviewing for relevance for mesh use in the pelvis by two independent reviewers with a third available in the case of disagreement, a total of 60 articles were included in the present review.
RESULTS: We found that many of the potential causes of PFDs are due to altered metabolism of patient extra cellular matrix (specifically collagen, elastin, and their respective enzymes) and as such repairs using native tissue may suffer from the same abnormalities leading to a subsequent lack of repair integrity. Mesh use, however, is not without its unique risks. Several publications have suggested that biomaterials may undergo alteration after implantation, but these findings have not been demonstrated in the normal milieu.
CONCLUSION: While the decision for the use of synthetic mesh is scientifically sound, its benefits and risks must be discussed with the patient in an informed decision making process.
Written by:
Colaco M, Mettu J, Badlani G. Are you the author?
Department of Urology, Wake Forest School of Medicine-Winston-Salem, NC.
Reference: BJU Int. 2014 May 29. Epub ahead of print.
doi: 10.1111/bju.12819
PubMed Abstract
PMID: 24889349
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