Mesh implants in incontinence and prolapse surgery: an ultrasound perspective

Surgeons dealing with female pelvic organ prolapse and female stress urinary incontinence have been using mesh implants for at least six decades. This practice has become very widespread since around 1995 due to the development of highly biocompatible synthetic suburethral slings. Over the last 10 years this trend has also extended to similar materials being used in prolapse surgery, causing major controversy. Anchored meshes seems to be effective in reducing prolapse recurrence when used for cystocele repair, but they do not guarantee a cure and complications are not uncommon. Imaging has a major, largely unrealized role to play in patient selection, the optimization of implant design, in surgical audit and in the management of complications and recurrence. In this article, the author will summarize the current role of imaging in the context of mesh surgery, both in incontinence and prolapse.