[Indications of mesh in surgical treatment of pelvic organ prolapse by vaginal route: expert consensus from the French College of Gynecologists and Obstetricians (CNGOF)]

Abstract

Objective: To determine the indications and contraindications concerning prosthetic surgery by vaginal route for pelvic organ prolapse.

Methods: Literature review and rating of proposals using a formal consensus method.

Results: Before surgery for genital prolapse, the patient should be counselled about the different existing techniques (abdominal and vaginal surgery with and without mesh), the reasons why the surgeon offered her the placement of a synthetic mesh and also other nonsurgical treatments (pelvic floor rehabilitation and pessary). The intervention must be preceded by an assessment of bothersome pelvic, urinary, digestive and sexual symptoms. For the surgical treatment of cystocele, the use of a synthetic mesh placed by vaginal route is not recommended routinely. It should be discussed on a case by case considering the risk/benefit ratio. In patients presenting with cystocele recurrence, the placement of a synthetic mesh is a reasonable option, in order to reduce the risk of cystocele recurrence. With the exception of a few situations (rectocele recurrence), the placement of a synthetic mesh is not recommended as first-line therapy for the surgical treatment of rectocele by vaginal route. In case of uterine or vaginal vault prolapse, repositioning the vaginal vault or uterus using synthetic mesh arms is not recommended as first-line surgical therapy.

Conclusion: Surgeons should implement established preventive recommendations that may reduce the risk of complications.

Keywords: Consensus d’experts; Cystocele; Cystocèle; Expert consensus; Genital prolapse; Guidelines; Mesh; Pelvic organ prolapse; Prolapsus; Prothèse; Recommandations; Rectocele; Rectocèle; Vaginal surgery; Vaginal vault; Voie vaginale.