Are recurrence rates for "traditional" transvaginal prolapse repairs really that high? What does the evidence show?

Pelvic organ prolapse (POP) is a common and bothersome condition. Multiple methods for surgical repair exist, and much attention has been given to improving the efficacy of repair by implementing mesh interposition. Standard (native tissue-based) repairs in the anterior compartment have long been thought to be associated with high anatomical recurrence rates and the currently available randomized controlled trials (RCTs) support this thinking. However, subjective improvement in pelvic pressure and bulging and quality of life indices are similarly improved in both standard and mesh-augmented repairs. No RCTs are available to compare standard and mesh-augmented repairs in the posterior compartment. Despite the presence of RCTs, the data is often inconsistent and questions remain regarding the optimal criteria to describe POP recurrence. While there is a role for both types of repair, the optimal patient scenario is not known.