Christopher R Chapple1, Francisco Cruz2, Xavier Deffieux3, Alfredo L Milani4, Salvador Arlandis5, Walter Artibani6, Ricarda M Bauer7, Fiona Burkhard8, Linda Cardozo9, David Castro-Diaz10, Jean Nicolas Cornu11, Jan Deprest12, Alfons Gunnemann13, Maria Gyhagen14, John Heesakkers15, Heinz Koelbl16, Sheila MacNeil17, Gert Naumann18, Jan-Paul W R Roovers19, Stefano Salvatore20, Karl-Dietrich Sievert21, Tufan Tarcan22, Frank Van der Aa23, Francesco Montorsi24, Manfred Wirth25, Mohamed Abdel-Fattah26. 1. Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom. Electronic address: c.r.chapple@shef.ac.uk. 2. Department of Urology, Hospital São João/Faculty of Medicine of Porto, Porto, Portugal; I3S Institute for Health, Porto, Portugal. 3. Department of Gynaecologic Surgery, Antoine Béclère Hospital, Paris South University, Clamart, France. 4. Department of Obstetrics & Gynaecology, Reinier de Graaf Hospital, Delft, The Netherlands. 5. Department of Urology, La Fe University and Polytechnic Hospital, Valencia, Spain. 6. Department of Urology, Azienda Ospedaliero Universitaria di Verona, Verona, Italy. 7. Department of Urology, Ludwig-Maximilians-University Muenchen, Klinikum Großhadern, Muenchen, Germany. 8. Department of Urology, University Hospital Bern, Bern, Switzerland. 9. Department of Urogynaecology, King's College Hospital, London, United Kingdom. 10. Department of Urology, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Canary Islands, Spain. 11. Department of Urology, Rouen University Hospital and University of Rouen, Rouen Cedex, France. 12. Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium. 13. Klinikum Lippe Urologische Klinik, Akademisches Lehrkrankenhaus der Georg-August-Universität Göttingen, Germany. 14. Department of Obstetrics and Gynecology, Södra Älvsborgs Hospital, Borås, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden. 15. Radboud UMC, Nijmegen, The Netherlands. 16. Department of General Gynaecology and Gynaecologic Oncology, Medical University of Vienna, Vienna, Austria. 17. Department of Tissue Engineering, University of Sheffield, Sheffield, United Kingdom. 18. Department of Obstetrics and Gynaecology, Helios-Klinikum, Erfurt, Germany. 19. Department of Obstetrics and Gynaecology, Academic Medical Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands. 20. Obstetrics and Gynaecology Unit, Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy. 21. Paracelsus Medical University, Salzburg, Austria. 22. Department of Urology, Marmara University School of Medicine, Istanbul, Turkey. 23. Department of Urology, University Hospitals Leuven, KU Leuven, Leuven, Belgium. 24. Department of Urology, Vita Salute San Raffaele University, Milan, Italy. 25. Department of Urology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany. 26. School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom.
Abstract
CONTEXT: Surgical nonautologous meshes have been used for several decades to repair abdominal wall herniae. Implantable materials have been adopted for the treatment of female and male stress urinary incontinence (SUI) and female pelvic organ prolapse (POP). OBJECTIVE: A consensus review of existing data based on published meta-analyses and reviews. EVIDENCE ACQUISITION: This document summarises the deliberations of a consensus group meeting convened by the European Association of Urology (EAU) and the European Urogynecological Association, to explore the current evidence relating to the use of polypropylene (PP) materials used for the treatment of SUI and POP, with reference to the 2016 EAU guidelines (European Association of Urology 2016), the European Commission's SCENIHR report on the use of surgical meshes (SCENIHR 2015), other available high-quality evidence, guidelines, and national recommendations. EVIDENCE SYNTHESIS: Current data suggest that the use of nonautologous durable materials in surgery has well-established benefits but significant risks, which are specific to the condition and location they are used for. Various graft-related complications have been described-such as infection, chronic pain including dyspareunia, exposure in the vagina, shrinkage, erosion into other organs of xenografts, synthetic PP tapes (used in SUI), and meshes (used in POP)-which differ from the complications seen with abdominal herniae. CONCLUSIONS: When considering surgery for SUI, it is essential to evaluate the available options, which may include synthetic midurethral slings (MUSs) using PP tapes, bulking agents, colposuspension, and autologous sling surgery. The use of synthetic MUSs for surgical treatment of SUI in both male and female patients has good efficacy and acceptable morbidity. Synthetic mesh for POP should be used only in complex cases with recurrent prolapse in the same compartment and restricted to those surgeons with appropriate training who are working in multidisciplinary referral centres. PATIENT SUMMARY: Synthetic slings can be safely used in the surgical treatment of stress incontinence in both male and female patients. Patients need to be aware of the alternative therapy and potential risks and complications of this therapy. Synthetic mesh for treating prolapse should be used only in complex cases with recurrent prolapse in specialist referral centres.
CONTEXT: Surgical nonautologous meshes have been used for several decades to repair abdominal wall herniae. Implantable materials have been adopted for the treatment of female and male stress urinary incontinence (SUI) and female pelvic organ prolapse (POP). OBJECTIVE: A consensus review of existing data based on published meta-analyses and reviews. EVIDENCE ACQUISITION: This document summarises the deliberations of a consensus group meeting convened by the European Association of Urology (EAU) and the European Urogynecological Association, to explore the current evidence relating to the use of polypropylene (PP) materials used for the treatment of SUI and POP, with reference to the 2016 EAU guidelines (European Association of Urology 2016), the European Commission's SCENIHR report on the use of surgical meshes (SCENIHR 2015), other available high-quality evidence, guidelines, and national recommendations. EVIDENCE SYNTHESIS: Current data suggest that the use of nonautologous durable materials in surgery has well-established benefits but significant risks, which are specific to the condition and location they are used for. Various graft-related complications have been described-such as infection, chronic pain including dyspareunia, exposure in the vagina, shrinkage, erosion into other organs of xenografts, synthetic PP tapes (used in SUI), and meshes (used in POP)-which differ from the complications seen with abdominal herniae. CONCLUSIONS: When considering surgery for SUI, it is essential to evaluate the available options, which may include synthetic midurethral slings (MUSs) using PP tapes, bulking agents, colposuspension, and autologous sling surgery. The use of synthetic MUSs for surgical treatment of SUI in both male and female patients has good efficacy and acceptable morbidity. Synthetic mesh for POP should be used only in complex cases with recurrent prolapse in the same compartment and restricted to those surgeons with appropriate training who are working in multidisciplinary referral centres. PATIENT SUMMARY: Synthetic slings can be safely used in the surgical treatment of stress incontinence in both male and female patients. Patients need to be aware of the alternative therapy and potential risks and complications of this therapy. Synthetic mesh for treating prolapse should be used only in complex cases with recurrent prolapse in specialist referral centres.
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