Biologic Grafts for Use in Pelvic Organ Prolapse Surgery: a Contemporary Review
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FEMALE UROLOGY (L COX, SECTION EDITOR)
Biologic Grafts for Use in Pelvic Organ Prolapse Surgery: a Contemporary Review Amanda L. Merriman 1
&
Michael J. Kennelly 1
Accepted: 15 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Pelvic organ prolapse (POP) is a common condition and there is a plethora of surgical techniques available to address this problem. We present a review of biologic grafts, including the latest literature to help guide a surgeon’s choice on the type of biologic materials to augment repairs. Recent Findings Since the 2019 Food and Drug Administration (FDA) ban on mesh, including xenograft, there is a sparsity of biologic graft products available for POP repairs. This has led to a significant decrease in surgical application. Surgeons must be familiar with the biochemical properties, processing, and clinical application of biologic grafts prior to use. They should also be familiar with alternative operative techniques that utilize autografts, although there is limited outcome data on these techniques. Summary With heightened awareness of mesh and its complications, biologic grafts have made a resurgence. Surgeons must be well versed on their available options. Current literature is limited, and studies have not demonstrated superiority of biologic graft over native tissue repairs for prolapse. Nevertheless, there is a role for these types of biologic graft material in specific patient populations. Future studies are warranted. Keywords Biologic grafts . Autograft . Allograft . Xenograft . Pelvic organ prolapse
Introduction Pelvic organ prolapse (POP) is a common medical condition, which affects approximately 50% of parous women over the age of 50. However, only 3–6% of women will report a bulge symptom, while 50% will have prolapse on examination [1, 2]. Data from the Woman’s Health Initiative (WHI) suggests an average of 33.6% of parous women have a cystocele, 18.5% rectocele, and 14.2% uterine or recurrent vaginal vault prolapse after hysterectomy [3]. It is estimated that a woman’s cumulative risk for prolapse surgery in the United States (US) is 12.6% by age 80, with a peak incidence of surgery around 65 years old. Annually, there are approximately 300,000 surgeries performed in the US [1, 4]. It is predicted that as the population continues to age, the total number of POP
This article is part of the Topical Collection on Female Urology * Amanda L. Merriman [email protected] 1
Atrium Health, Division of Urogynecology and Pelvic Surgery, 2001 Vail Avenue, Charlotte, NC 28207, USA
procedures will also continue to rise by 50% over the next 40–50 years [5]. The traditional repair for prolapse utilizes a woman’s native tissues, more specifically, an anterior or posterior plication (colporrhaphy),uterosacral ligament suspension (USLS), or a sacrospinous ligament fixation (SSLF). Multiple studies have investigated the outcomes of native tissue repairs. The 5-year outcomes of the Operations and Pelvic Muscle Training
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