Department of Obstetrics/Gynecology, Harvard Medical School, New England Center for Urogynecology, Newton Wellesley Hospital/Brigham and Women's Hospital, Boston, Massachusetts, USA.
Curr Opin Obstet Gynecol. 2012 Oct;24(5):337-42. doi: 10.1097/GCO.0b013e328357a1ad.
Due to technological advancements, transvaginal mesh use for prolapse and incontinence has exploded over the last decade with mixed results. Recent governmental guidelines have further increased the controversy regarding the risks and benefits of mesh use forcing clinicians to critically review the available data regarding transvaginal mesh use.
With the success of the transvaginal tape procedure introduced in 1995 and re-popularization of the abdominal sacrocolpopexy using synthetic mesh, pelvic surgeons began to feel more comfortable using mesh in urogynecologic procedures and increasingly adopted the use of transvaginal mesh for repair of pelvic prolapse with the hopes of creating better long-term results with minimal complications. With introduction of commercially available kits and widespread adoption of these procedures amongst pelvic surgeons and general gynecologists, there is increasing concern regarding related complications including mesh exposure, dyspareunia/pelvic pain, infection, and organ injury. This has resulted in recent reappraisal of vaginal mesh use, increased medicolegal risk, and withdrawal of selected products.
The data regarding transvaginal mesh use are controversial and incomplete. Its use is still in its infancy in terms of material development and clinical/scientific study, and clinicians should be careful and judicious in its use.
由于技术的进步，过去十年中，阴道网片在脱垂和尿失禁治疗中的应用呈爆炸式增长，但其结果好坏参半。最近的政府指南进一步增加了关于网片使用的风险和益处的争议，迫使临床医生批判性地审查关于阴道网片使用的现有数据。
随着 1995 年推出的阴道吊带手术的成功以及使用合成网片的经腹骶骨阴道固定术的重新普及，盆腔外科医生开始在妇科泌尿科手术中更舒适地使用网片，并越来越多地采用阴道网片治疗盆腔脱垂，希望能取得更好的长期效果，同时尽量减少并发症。随着市售套件的引入以及盆腔外科医生和普通妇科医生对这些手术的广泛采用，与网片相关的并发症（包括网片暴露、性交困难/盆腔疼痛、感染和器官损伤）越来越令人担忧。这导致了最近对阴道网片使用的重新评估、医疗法律风险的增加以及某些产品的撤回。
阴道网片使用的数据存在争议且不完整。就材料开发和临床/科学研究而言，其使用仍处于起步阶段，临床医生在使用时应谨慎明智。
