New Procedures for Pelvic Floor Repair: Progress or Propaganda?

Abstract

New procedures and new materials are introduced annually to the gynecologic surgeon, with the implication that new is better. Although often this implication may be the case, most new products and procedures lack clinical outcome and safety data over a clinically relevant period. In addition, products may have substantial differences in their makeup – synthetic, biologic, or other characteristics – that make direct comparisons inaccurate or impossible. We review why pelvic organ prolapse occurs and why procedures fail, and we summarize available data on restorative and compensatory surgical procedures, in attempting to determine whether new procedures for pelvic floor repair represent progress or propaganda.

Zusammenfassung

Jedes Jahr werden dem gynäkologischen Chirurgen neue Verfahren und neue Materialien unterbreitet, mit der Implikation, dass neu auch besser sein muss. Obwohl diese Implikation oftmals auch zutreffen mag, fehlt es den meisten neuen Produkten und Verfahren an klinisch relevanten Ergebnissen und an Sicherheitsdaten über eine klinisch relevante Zeitspanne. Ferner gibt es wesentliche Unterschiede – synthetische, biologisch oder andere Merkmale – im Aufbau dieser Produkte, welche einen direkten Vergleich ungenau oder gar unmöglich machen. Wir geben einen Überblick über die Gründe für einen Prolapsus im Beckbereich sowie über die Umstände, die zu einem Fehlschlag des Verfahrens führen können. Die verfügbaren Informationen zu Wiederherstellungsoperationen und kompensatorischen Operationen werden kurz zusammengefasst. Dabei versuchen wir festzustellen, ob neue Verfahren zur Reparatur des Beckenbodens einen Fortschritt darstellen oder als Propaganda zu werten sind.

Key words

biomaterials - gynecologic surgical procedures - pelvic floor - prolapse - surgical mesh

Schlüsselwörter

Biomaterialien - gynäkologisch‐chirurgisches Verfahren - Beckenboden - Prolapsus - chirurgisches Netz

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