Women who undergo pelvic organ prolapse (POP) surgery using synthetic vaginal implants (mesh or sling) face a greater risk of vaginal wall erosion if they are smokers or have had a hysterectomy, according to a new systematic review and meta‑analysis.
Researchers analysed 36 studies drawn from major medical databases, pooling data on patients who developed vaginal wall erosion (VWE) after POP repair with synthetic implants. The analysis found that a history of smoking and undergoing a hysterectomy at the same time as POP repair significantly increase the odds of erosion.
Understanding Pelvic Organ Prolapse and Surgical Options
Pelvic organ prolapse, where pelvic tissues sag or drop, is common in women over 50, with many opting for surgery using mesh implants to strengthen the pelvic floor. While mesh can improve anatomical outcomes, it carries a risk, erosion of the vaginal wall remains a troubling complication that has prompted restrictions or bans in some regions.
The authors registered their protocol in advance and followed PRISMA guidelines to ensure a fair, unbiased review. They included a wide range of patient-level factors, such as age, body mass index, comorbidities, menopausal status, type of mesh, and surgical technique.
POP Surgery and Vaginal Mesh: Key Risks Identified
While other factors were explored, the meta‑analysis revealed the strongest evidence for two risks: smoking and concurrent hysterectomy. Unfortunately, the authors note that many of the included studies had varying designs and methodologies, and some lacked thorough control groups, meaning more robust, prospective studies are needed to validate and deepen understanding of these risks.
These findings carry practical implications for surgeons and patients. The authors suggest that pre‑operative assessment should carefully account for smoking status and surgical planning around the uterus, as these may guide decisions about whether to use synthetic implants or choose alternative options. But they caution that without more high-quality comparative research, clinical recommendations must remain tentative.
In short, this meta-analysis provides evidence that two modifiable or avoidable factors, smoking and the removal of the uterus, are linked to higher rates of vaginal mesh erosion, potentially helping to tailor safer POP surgery strategies.
Reference
Ács J et al. Risk factors for vaginal wall erosion after pelvic organ prolapse surgery with implant: a systematic review and meta-analysis. Sci Rep. 2025;15:40780
