There are insufficient data at present to draw any evidence - based conclusions with regard to the role of prosthetic materials in prolapse surgery. Part of the problem arises from the paucity of baseline data regarding the efficacy of “traditional” anterior and posterior vaginal repairs. As a result of this the efficacy of adding prosthetic material for primary or recurrent prolapse affecting these compartments is difficult to assess. While adding synthetic type 1 mesh grafts suggests a theoretical advantage, this must be balanced against increased cost and potential morbidity.
There is also a need for further long – term prospective studies, ideally in the form of randomized controlled trials as well as from structured personal series audits, in order to determine the long – term efficacy and potential morbidity associated with the use of prosthetic materials in primary or recurrent prolapse repair. Standardized criteria for staging POP, adequate follow – up and assessment of effects of surgery on bladder, bowel and sexual function are required to determine whether or not the use of these grafts confers advantage over standard prolapse repair, and in which category of patient they should be employed.
This will allow appropriate selection of both the type of prosthesis and the optimal surgical approach in women requiring reconstructive pelvic floor surgery. However, synthetic prostheses will not compensate for poor surgical techniques or a poorly conceived procedure. A host of “copy – cat” prostheses are available on the market, riding the wave of more established mainstream product usage. A prudent surgeon will evaluate published data on specific products before using “me – too” operations.