Mesh is still used in prolapse surgery, but only through specific approaches. In 2019, the FDA ordered all transvaginal mesh products for pelvic organ prolapse off the U.S. market. However, mesh placed through the abdomen during a procedure called sacrocolpopexy remains legal, widely performed, and considered effective. Mesh slings for stress urinary incontinence, a related but separate condition, also remain available.
The distinction matters because most of the complications that made headlines were linked to mesh inserted through the vaginal wall. Understanding which types of mesh were banned, which are still in use, and what the alternatives look like can help you have a more informed conversation with your surgeon.
What the FDA Banned in 2019
On April 16, 2019, the FDA ordered the only two manufacturers still selling transvaginal mesh for prolapse repair to stop immediately. The three affected products were Boston Scientific’s Uphold LITE Vaginal Support System and Xenform Soft Tissue Repair System, along with Coloplast’s Restorelle DirectFix Anterior. The FDA determined that the submitted data did not provide reasonable assurance of safety and effectiveness for these devices.
This order applied specifically to synthetic mesh implanted through the vagina to treat pelvic organ prolapse. It did not apply to mesh used in abdominal prolapse surgery or to mesh slings used for urinary incontinence. That distinction is the source of most confusion around this topic.
Where Mesh Is Still Used
Sacrocolpopexy is the primary prolapse surgery that still uses synthetic mesh. In this procedure, a surgeon attaches mesh to the top of the vagina and anchors it to a bone at the base of the spine (the sacrum), essentially creating an internal support structure. The surgery is performed through the abdomen, either with open incisions, laparoscopically, or with robotic assistance.
This approach has a notably lower complication profile than transvaginal mesh. The median rate of mesh erosion through the vaginal wall is about 4% within the first two years after surgery. While that’s not zero, it’s substantially lower than the rates seen with transvaginal placement. Sacrocolpopexy is generally used for vault prolapse, which is when the top of the vagina descends after a hysterectomy, though it can be used in other situations as well.
The most common complications reported with abdominal mesh repair, in order of frequency, are mesh erosion, pain, infection, scar tissue formation, bleeding, and incontinence. Less common issues include nerve or muscle problems, organ perforation, and painful intercourse.
Mesh Slings for Incontinence Are Different
If you’re researching prolapse surgery, you may also be dealing with stress urinary incontinence, since the two conditions frequently overlap. Mesh slings for incontinence, known as mid-urethral slings, are still FDA-approved and remain one of the most common surgical treatments for urine leakage during coughing, sneezing, or exercise.
These slings use a small, narrow strip of mesh placed under the urethra, which is a very different application from the larger pieces of mesh that were used to reinforce vaginal walls during prolapse repair. The FDA continues to monitor these devices and has found that both traditional mid-urethral slings and shorter “mini-slings” show comparable performance through at least 36 months. That said, a mesh sling is a permanent implant, and having one can make future surgical repairs more complex if needed.
Native Tissue Repair: The Main Alternative
For prolapse repair through the vagina, native tissue repair is now the standard approach. This means the surgeon uses your own tissue, along with sutures, to reconstruct the vaginal wall support without implanting any synthetic material. Common native tissue procedures include anterior and posterior colporrhaphy (repairs to the front or back vaginal wall) and various types of vaginal vault suspension.
A large study of over 110,000 women found that native tissue repairs actually had a lower overall reoperation rate than mesh repairs: 4.3% compared to 5.4%. While mesh did reduce the chance of needing repeat surgery specifically for prolapse recurrence by about 0.7%, it also increased the chance of needing a second surgery for a mesh-related complication by about 1.5%. In other words, the mesh solved one problem but created enough new ones to cancel out the benefit and then some.
Other reviews of the research have found similar patterns. Across multiple studies, native tissue repair carries roughly a 5% reoperation rate, while mesh repair groups have shown rates around 5% to 9% when mesh complications requiring additional surgery are factored in.
Biological Grafts Haven’t Proven Superior
Some surgeons have explored using biological grafts (materials derived from human or animal tissue) or absorbable synthetic mesh as a middle ground between permanent mesh and native tissue alone. The idea is appealing: reinforce the repair with something that eventually dissolves or integrates, avoiding the long-term risks of permanent synthetic material.
The evidence, however, has been disappointing. A Cochrane review, the gold standard for evaluating medical research, found no meaningful benefit from either absorbable mesh or biological grafts compared to native tissue repair. At one to three years after surgery, there was no significant difference in how often women were aware of their prolapse, how often prolapse recurred on examination, or how often repeat surgery was needed. In short, these materials add cost and complexity without improving outcomes.
How Surgeons Choose the Approach
The choice between native tissue repair and mesh-based sacrocolpopexy depends largely on which part of the vagina has prolapsed, the severity of the prolapse, whether you’ve had a hysterectomy, and your overall health. Sacrocolpopexy with mesh is most commonly recommended for apical prolapse (descent of the vaginal vault) and is often favored in younger, more active patients because of its durability. Native tissue repair through the vagina is typically used for prolapse of the front or back vaginal walls and may be preferred in older patients or those who want to avoid abdominal surgery.
Recurrence is a reality with any prolapse repair. Prolapse is fundamentally a problem of weakened connective tissue and pelvic floor support, and no surgical technique eliminates the underlying vulnerability. Some women will need additional procedures regardless of the approach chosen. Pelvic floor physical therapy before and after surgery can help support the repair, and nonsurgical options like vaginal pessaries remain a reasonable choice for women who prefer to avoid or delay surgery entirely.
The joint clinical guidelines from the American Urogynecologic Society and the American College of Obstetricians and Gynecologists, originally published in 2019 and reaffirmed in 2024, reflect this landscape: transvaginal mesh for prolapse is off the table, sacrocolpopexy with mesh remains an established option, and native tissue repair is the primary vaginal approach.