Point-counterpoint: Transvaginal placement of synthetic grafts to repair pelvic organ prolapse

An ever-growing, aging population increases demand for effective, minimally invasive surgeries for pelvic organ prolapse (POP). The most recent urogynecologic debate relates to the use of mesh kits for the transvaginal placement of synthetic grafts to surgically repair POP. Recent publications demonstrate improved outcomes compared with traditional endogenous tissue suture repairs, yet many question the use of these kits due to complications and lack of long-term related research. Some believe that proper technique and training enable patients to achieve durable outcomes with low morbidity via a minimally invasive, cost-effective surgical approach. However, because these kits are often used by novice surgeons with little understanding of pelvic floor anatomy and traditional repairs, others urge caution before their routine use and implementation. Further, some believe that surgeons must not always wait for robust level I support, but others insist that the medical community should encourage restraint and promote well-designed prospective studies comparing these kits to traditional repairs before subjecting patients to potentially harmful, ineffective products. This article presents arguments in favor and against transvaginal placement of synthetic grafts to repair POP.