For vaginal repair, benefits of mesh must be weighed against harms

Synthetic mesh is more effective for correcting vaginal prolapse than using a woman’s own tissue, but the overall benefit is small, according to a fresh look at some past research.

In vaginal prolapse, the vagina may fall out of its normal position because of weakened muscles and ligaments. Often, nearby structures such as the uterus, rectum, and bladder fall down into the vagina as well.

Researchers have found that up to three years after surgery, women whose prolapse was repaired with artificial mesh were less likely to be aware of recurrent prolapse than those whose repair was done with natural tissue. But they were also more likely to have incontinence, exposed mesh or another surgery.

About one in 20 women whose prolapse was fixed with natural tissue had a second operation, compared to about one in 10 women who got artificial mesh, said lead author Dr. Christopher Maher, of the Royal Brisbane Women’s Hospital in Australia.

Prolapse is seen in 40 to 60 percent of mothers, the researchers report in the Cochrane Library. Out of every 10,000 women in the U.S., about 10 to 30 undergo surgery to repair prolapses each year, they add.

Repairs using mesh became popular in the late 1990s and early 2000s after it was successfully used in other types of operations, wrote Dr. Cindy Farquhar, of the University of Auckland in New Zealand, in an accompanying editorial.