Cystocele and rectocele repair: More success with mesh?

• Tutoplast and Alloderm appear to have the best tensile strength, maximum load to capacity, and microscopic architecture similar to the original tissue.^15-17 However, these qualities were documented prior to implantation in vivo.
• Slings appear to help prevent cystocele recurrences, according to a study by Goldberg et al.¹⁸
• A fascial patch had no benefit when placed as an overlay in the anterior compartment in a randomized, controlled trial (involving 162 women) by Sand et al.¹²
• Marlex. One group of women with recurrent prolapse underwent synthetic graft (Marlex) augmentation with bilateral ATFP attachment, while the other group had anterior colporrhaphy only.¹⁹ None of the women who received grafts had further recurrence, while 33% of the control group did. However, 25% of the women with the graft had vaginal erosions.
• Polyglactin 910 had a protective effect when embedded in the plication, according to Sand et al.¹² However, it had no benefit when used as an overlay to a traditional repair in a study by Weber et al.⁴ The discrepancy may be related to small sample size; the study by Weber et al was powered to detect only a 30% difference. However, these studies suggest that it is not only the type of graft that is important, but how it is used or attached.

In general, synthetic grafts may have slightly higher success rates, whereas biologic materials appear to be better tolerated.

Prospective, comparative trials of these materials are desperately needed.