Critical Assessment of Pelvic Floor Surgical Reconstruction Outcome

Purpose: To summarize the most important evidence available in the field of pelvic floor reconstruction surgery, as well as at indicating the proper methodology for studies in the field. Methods: A non systematic review of the literature was performed by means of MEDLINE search. Results: The available evidence supported the use of mesh in anterior vaginal wall prolapse surgery, the indications both for abdominal sacrocolpopexy in case of vaginal vault prolapse and posterior colporrhaphy in case of rectocele. In patients with vaginal vault prolapse, two recently published RCTs recommended the use of polypropylene mesh during sacrocolpopexy, as well as the use of a prophylactic concomitant antiincontinence procedure, such as Burch colposuspension. However, the data regarding lower urinary tract, bowel, sexual functions, generic quality of life issues, and long-term outcome were insufficient. Conclusions: Few high-quality RCTs are available in the field of pelvic floor reconstruction. Further RCTs with long-term follow-up and attention to the assessment of functional outcomes by means of validated questionnaires and re-evaluation at longer follow-up of most of the currently available trials are strongly desired to improve evidence-based management in urogynecology. # 2006 European Association of Urology and European Board of Urology. Published by Elsevier B.V. All rights reserved.