Optimal repair of pelvic organ prolapse: the debate continues

As the need for durable pelvic organ prolapse (POP) repairs continues to increase, greater scrutiny has been placed on finding the optimal repair. Evidence-based literature indicates that the durability of standard (plication-type) repairs in the anterior compartment is suboptimal and that graft augmentation, especially with non-absorbable, synthetic mesh, may be superior. However, while appealing, the transvaginal mesh used for POP repair may be associated with adverse sequelae, such as erosion, extrusion, and infection. Additionally, there is concern regarding the potential long-term outcomes, such as dyspareunia, chronic pelvic pain, and vaginal distortion, which may occur even in the absence of frank extrusion. Recent warnings by the U.S. FDA among other groups regarding adverse events after transvaginal mesh implantation have fueled the debate even further. Our aim is to summarize the available literature regarding the available surgical options for the repair of POP.