Mesh in prolapse surgery

Prolapse repair with synthetic mesh has become an area of debate in the last few years. The rationale for mesh use in prolapse surgery, the surgical outcomes and its complication profile will help us to understand the concerns and controversies regarding it. The lifetime risk of undergoing surgery for prolapse by age 80 is around 11 % and reoperation rate is quoted around 29 % [1]. The recurrence risk and the need for reoperation in nearly one-third to one-fourth of patients with prolapse surgeries means there is a need for more robust techniques in prolapse repair. Our understanding of pelvic floor anatomy changed dramatically since the description of "levels of pelvic organ support" by John DeLancey [2]. In order to fully understand the dynamics of prolapse surgery, both native tissue and mesh repair, it is important to have a brief overview of the functional anatomy of the pelvic floor, which has been covered adequately in an earlier chapter of this textbook. Many of the treatments for pelvic organ prolapse (POP) offered today have been developed bearing in mind this renewed understanding of pelvic floor anatomy