Reply

The last several years have seen widespread use of mesh surgery, especially for prolapse management without sufficient long-term safety and efficacy data. Some surgeons have developed “homemade” modifications in an effort to reduce the cost of mesh-kits while maintaining the high anatomic success achieved with mesh-enforced repairs. In this respect, our report has made a valuable contribution to the scarce literature data regarding the long-term outcomes of this approach for the management of stress incontinence and prolapse. In brief, mesh slings seem to work well for incontinence without an increased risk of complications, whereas the use of “surgeon-tailored” mesh for concomitant prolapse repair may be associated with a substantial risk of complications that require additional interventions. We agree that mesh-related procedures necessitate specific surgeon training and proper patient selection, and benefits of “homemade” modifications to decrease the cost must be balanced against the complications and postoperative adverse events as determined by the surgeon's own experience and quality of the implant material used. In the present series, we used Gal-Mesh (Gallini Medical Devices, Mantova, Italy) based on its affordable price and good tissue bio-compatibility as evidenced by previous experimental studies (reference no. 10 in our original manuscript). With the advent of technology, better products with lower weight and much less rigidity are being introduced to the market, which will possibly lead to a significant reduction of mesh-related complications owing to less tissue reaction. During the last 2 years, we have shifted toward using a lighter-weight, composite (polyglactin-polypropylene) mesh for pelvic floor reconstruction. We await our long-term results and wonder how the choice of implant material will affect our complication rates. Although the characteristics of the mesh are important, there seem to be other unresolved critical factors that determine the occurrence of mesh-related complications. Better definition of patient selection criteria and specific surgeon training are crucial to establish the future role of mesh-enforced pelvic floor reconstructions.