Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence

Christopher R Chapple, Francisco Cruz, Xavier Deffieux, Alfredo L Milani, Salvador Arlandis, Walter Artibani, Ricarda M Bauer, Fiona Burkhard, Linda Cardozo, David Castro-Diaz, Jean Nicolas Cornu, Jan Deprest, Alfons Gunnemann, Maria Gyhagen, John Heesakkers, Heinz Koelbl, Sheila MacNeil, Gert Naumann, Jan-Paul W R Roovers, Stefano SalvatoreKarl-Dietrich Sievert, Tufan Tarcan, Frank Van der Aa, Francesco Montorsi, Manfred Wirth, Mohamed Abdel-Fattah

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

CONTEXT: Surgical nonautologous meshes have been used for several decades to repair abdominal wall herniae. Implantable materials have been adopted for the treatment of female and male stress urinary incontinence (SUI) and female pelvic organ prolapse (POP).

OBJECTIVE: A consensus review of existing data based on published meta-analyses and reviews.

EVIDENCE ACQUISITION: This document summarises the deliberations of a consensus group meeting convened by the European Association of Urology (EAU) and the European Urogynecological Association, to explore the current evidence relating to the use of polypropylene (PP) materials used for the treatment of SUI and POP, with reference to the 2016 EAU guidelines (European Association of Urology 2016), the European Commission's SCENIHR report on the use of surgical meshes (SCENIHR 2015), other available high-quality evidence, guidelines, and national recommendations.

EVIDENCE SYNTHESIS: Current data suggest that the use of nonautologous durable materials in surgery has well-established benefits but significant risks, which are specific to the condition and location they are used for. Various graft-related complications have been described-such as infection, chronic pain including dyspareunia, exposure in the vagina, shrinkage, erosion into other organs of xenografts, synthetic PP tapes (used in SUI), and meshes (used in POP)-which differ from the complications seen with abdominal herniae.

CONCLUSIONS: When considering surgery for SUI, it is essential to evaluate the available options, which may include synthetic midurethral slings (MUSs) using PP tapes, bulking agents, colposuspension, and autologous sling surgery. The use of synthetic MUSs for surgical treatment of SUI in both male and female patients has good efficacy and acceptable morbidity. Synthetic mesh for POP should be used only in complex cases with recurrent prolapse in the same compartment and restricted to those surgeons with appropriate training who are working in multidisciplinary referral centres.

PATIENT SUMMARY: Synthetic slings can be safely used in the surgical treatment of stress incontinence in both male and female patients. Patients need to be aware of the alternative therapy and potential risks and complications of this therapy. Synthetic mesh for treating prolapse should be used only in complex cases with recurrent prolapse in specialist referral centres.

Original languageEnglish
Pages (from-to)424-431
Number of pages8
JournalEuropean Urology
Volume72
Issue number3
Early online date14 Apr 2017
DOIs
Publication statusPublished - Sep 2017

Fingerprint

Pelvic Organ Prolapse
Stress Urinary Incontinence
Urology
Consensus
Polypropylenes
Prolapse
Surgical Mesh
Abdominal Hernia
Suburethral Slings
Referral and Consultation
Guidelines
Dyspareunia
Therapeutics
Group Processes
Abdominal Wall
Vagina
Complementary Therapies
Heterografts
Chronic Pain
Meta-Analysis

Keywords

  • Journal Article
  • Review
  • mesh
  • stress urinary incontinence
  • pelvic organ prolapse
  • consensus statement

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence. / Chapple, Christopher R; Cruz, Francisco; Deffieux, Xavier; Milani, Alfredo L; Arlandis, Salvador; Artibani, Walter; Bauer, Ricarda M; Burkhard, Fiona; Cardozo, Linda; Castro-Diaz, David; Cornu, Jean Nicolas; Deprest, Jan; Gunnemann, Alfons; Gyhagen, Maria; Heesakkers, John; Koelbl, Heinz; MacNeil, Sheila; Naumann, Gert; Roovers, Jan-Paul W R; Salvatore, Stefano; Sievert, Karl-Dietrich; Tarcan, Tufan; Van der Aa, Frank; Montorsi, Francesco; Wirth, Manfred; Abdel-Fattah, Mohamed.

In: European Urology, Vol. 72, No. 3, 09.2017, p. 424-431.

Research output: Contribution to journalArticle

Chapple, CR, Cruz, F, Deffieux, X, Milani, AL, Arlandis, S, Artibani, W, Bauer, RM, Burkhard, F, Cardozo, L, Castro-Diaz, D, Cornu, JN, Deprest, J, Gunnemann, A, Gyhagen, M, Heesakkers, J, Koelbl, H, MacNeil, S, Naumann, G, Roovers, J-PWR, Salvatore, S, Sievert, K-D, Tarcan, T, Van der Aa, F, Montorsi, F, Wirth, M & Abdel-Fattah, M 2017, 'Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence', European Urology, vol. 72, no. 3, pp. 424-431. https://doi.org/10.1016/j.eururo.2017.03.048
Chapple, Christopher R ; Cruz, Francisco ; Deffieux, Xavier ; Milani, Alfredo L ; Arlandis, Salvador ; Artibani, Walter ; Bauer, Ricarda M ; Burkhard, Fiona ; Cardozo, Linda ; Castro-Diaz, David ; Cornu, Jean Nicolas ; Deprest, Jan ; Gunnemann, Alfons ; Gyhagen, Maria ; Heesakkers, John ; Koelbl, Heinz ; MacNeil, Sheila ; Naumann, Gert ; Roovers, Jan-Paul W R ; Salvatore, Stefano ; Sievert, Karl-Dietrich ; Tarcan, Tufan ; Van der Aa, Frank ; Montorsi, Francesco ; Wirth, Manfred ; Abdel-Fattah, Mohamed. / Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence. In: European Urology. 2017 ; Vol. 72, No. 3. pp. 424-431.
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abstract = "CONTEXT: Surgical nonautologous meshes have been used for several decades to repair abdominal wall herniae. Implantable materials have been adopted for the treatment of female and male stress urinary incontinence (SUI) and female pelvic organ prolapse (POP).OBJECTIVE: A consensus review of existing data based on published meta-analyses and reviews.EVIDENCE ACQUISITION: This document summarises the deliberations of a consensus group meeting convened by the European Association of Urology (EAU) and the European Urogynecological Association, to explore the current evidence relating to the use of polypropylene (PP) materials used for the treatment of SUI and POP, with reference to the 2016 EAU guidelines (European Association of Urology 2016), the European Commission's SCENIHR report on the use of surgical meshes (SCENIHR 2015), other available high-quality evidence, guidelines, and national recommendations.EVIDENCE SYNTHESIS: Current data suggest that the use of nonautologous durable materials in surgery has well-established benefits but significant risks, which are specific to the condition and location they are used for. Various graft-related complications have been described-such as infection, chronic pain including dyspareunia, exposure in the vagina, shrinkage, erosion into other organs of xenografts, synthetic PP tapes (used in SUI), and meshes (used in POP)-which differ from the complications seen with abdominal herniae.CONCLUSIONS: When considering surgery for SUI, it is essential to evaluate the available options, which may include synthetic midurethral slings (MUSs) using PP tapes, bulking agents, colposuspension, and autologous sling surgery. The use of synthetic MUSs for surgical treatment of SUI in both male and female patients has good efficacy and acceptable morbidity. Synthetic mesh for POP should be used only in complex cases with recurrent prolapse in the same compartment and restricted to those surgeons with appropriate training who are working in multidisciplinary referral centres.PATIENT SUMMARY: Synthetic slings can be safely used in the surgical treatment of stress incontinence in both male and female patients. Patients need to be aware of the alternative therapy and potential risks and complications of this therapy. Synthetic mesh for treating prolapse should be used only in complex cases with recurrent prolapse in specialist referral centres.",
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author = "Chapple, {Christopher R} and Francisco Cruz and Xavier Deffieux and Milani, {Alfredo L} and Salvador Arlandis and Walter Artibani and Bauer, {Ricarda M} and Fiona Burkhard and Linda Cardozo and David Castro-Diaz and Cornu, {Jean Nicolas} and Jan Deprest and Alfons Gunnemann and Maria Gyhagen and John Heesakkers and Heinz Koelbl and Sheila MacNeil and Gert Naumann and Roovers, {Jan-Paul W R} and Stefano Salvatore and Karl-Dietrich Sievert and Tufan Tarcan and {Van der Aa}, Frank and Francesco Montorsi and Manfred Wirth and Mohamed Abdel-Fattah",
note = "This paper has also been influenced by discussions during the meetings of the European Cooperation in Science and Technology (COST) Biomedicine and Molecular Biosciences Action BM1209 Regenerative Sphincter Therapy, funded by the European Commission.",
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T1 - Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence

AU - Chapple, Christopher R

AU - Cruz, Francisco

AU - Deffieux, Xavier

AU - Milani, Alfredo L

AU - Arlandis, Salvador

AU - Artibani, Walter

AU - Bauer, Ricarda M

AU - Burkhard, Fiona

AU - Cardozo, Linda

AU - Castro-Diaz, David

AU - Cornu, Jean Nicolas

AU - Deprest, Jan

AU - Gunnemann, Alfons

AU - Gyhagen, Maria

AU - Heesakkers, John

AU - Koelbl, Heinz

AU - MacNeil, Sheila

AU - Naumann, Gert

AU - Roovers, Jan-Paul W R

AU - Salvatore, Stefano

AU - Sievert, Karl-Dietrich

AU - Tarcan, Tufan

AU - Van der Aa, Frank

AU - Montorsi, Francesco

AU - Wirth, Manfred

AU - Abdel-Fattah, Mohamed

N1 - This paper has also been influenced by discussions during the meetings of the European Cooperation in Science and Technology (COST) Biomedicine and Molecular Biosciences Action BM1209 Regenerative Sphincter Therapy, funded by the European Commission.

PY - 2017/9

Y1 - 2017/9

N2 - CONTEXT: Surgical nonautologous meshes have been used for several decades to repair abdominal wall herniae. Implantable materials have been adopted for the treatment of female and male stress urinary incontinence (SUI) and female pelvic organ prolapse (POP).OBJECTIVE: A consensus review of existing data based on published meta-analyses and reviews.EVIDENCE ACQUISITION: This document summarises the deliberations of a consensus group meeting convened by the European Association of Urology (EAU) and the European Urogynecological Association, to explore the current evidence relating to the use of polypropylene (PP) materials used for the treatment of SUI and POP, with reference to the 2016 EAU guidelines (European Association of Urology 2016), the European Commission's SCENIHR report on the use of surgical meshes (SCENIHR 2015), other available high-quality evidence, guidelines, and national recommendations.EVIDENCE SYNTHESIS: Current data suggest that the use of nonautologous durable materials in surgery has well-established benefits but significant risks, which are specific to the condition and location they are used for. Various graft-related complications have been described-such as infection, chronic pain including dyspareunia, exposure in the vagina, shrinkage, erosion into other organs of xenografts, synthetic PP tapes (used in SUI), and meshes (used in POP)-which differ from the complications seen with abdominal herniae.CONCLUSIONS: When considering surgery for SUI, it is essential to evaluate the available options, which may include synthetic midurethral slings (MUSs) using PP tapes, bulking agents, colposuspension, and autologous sling surgery. The use of synthetic MUSs for surgical treatment of SUI in both male and female patients has good efficacy and acceptable morbidity. Synthetic mesh for POP should be used only in complex cases with recurrent prolapse in the same compartment and restricted to those surgeons with appropriate training who are working in multidisciplinary referral centres.PATIENT SUMMARY: Synthetic slings can be safely used in the surgical treatment of stress incontinence in both male and female patients. Patients need to be aware of the alternative therapy and potential risks and complications of this therapy. Synthetic mesh for treating prolapse should be used only in complex cases with recurrent prolapse in specialist referral centres.

AB - CONTEXT: Surgical nonautologous meshes have been used for several decades to repair abdominal wall herniae. Implantable materials have been adopted for the treatment of female and male stress urinary incontinence (SUI) and female pelvic organ prolapse (POP).OBJECTIVE: A consensus review of existing data based on published meta-analyses and reviews.EVIDENCE ACQUISITION: This document summarises the deliberations of a consensus group meeting convened by the European Association of Urology (EAU) and the European Urogynecological Association, to explore the current evidence relating to the use of polypropylene (PP) materials used for the treatment of SUI and POP, with reference to the 2016 EAU guidelines (European Association of Urology 2016), the European Commission's SCENIHR report on the use of surgical meshes (SCENIHR 2015), other available high-quality evidence, guidelines, and national recommendations.EVIDENCE SYNTHESIS: Current data suggest that the use of nonautologous durable materials in surgery has well-established benefits but significant risks, which are specific to the condition and location they are used for. Various graft-related complications have been described-such as infection, chronic pain including dyspareunia, exposure in the vagina, shrinkage, erosion into other organs of xenografts, synthetic PP tapes (used in SUI), and meshes (used in POP)-which differ from the complications seen with abdominal herniae.CONCLUSIONS: When considering surgery for SUI, it is essential to evaluate the available options, which may include synthetic midurethral slings (MUSs) using PP tapes, bulking agents, colposuspension, and autologous sling surgery. The use of synthetic MUSs for surgical treatment of SUI in both male and female patients has good efficacy and acceptable morbidity. Synthetic mesh for POP should be used only in complex cases with recurrent prolapse in the same compartment and restricted to those surgeons with appropriate training who are working in multidisciplinary referral centres.PATIENT SUMMARY: Synthetic slings can be safely used in the surgical treatment of stress incontinence in both male and female patients. Patients need to be aware of the alternative therapy and potential risks and complications of this therapy. Synthetic mesh for treating prolapse should be used only in complex cases with recurrent prolapse in specialist referral centres.

KW - Journal Article

KW - Review

KW - mesh

KW - stress urinary incontinence

KW - pelvic organ prolapse

KW - consensus statement

U2 - 10.1016/j.eururo.2017.03.048

DO - 10.1016/j.eururo.2017.03.048

M3 - Article

C2 - 28413126

VL - 72

SP - 424

EP - 431

JO - European Urology

JF - European Urology

SN - 0302-2838

IS - 3

ER -