Biologic grafts for pelvic organ prolapse repairs: what have we learned in the last 20 years?

Purpose of review The ideal graft material for the augmentation of pelvic organ prolapse (POP) has yet to be discovered. While synthetic mesh offers durable repairs this can be at the expense of mesh complications. Biologic grafts have been considered an alternative. This chapter reviews biologic graft materials as applied to POP surgery. Recent findings The heterogeneity of available graft materials and definitions of success in POP literature make comparisons difficult. There may be utility in the augmentation of apical prolapse with autologous grafts. There is also modest evidence to support anterior wall augmentation with biologic grafts. However, a 2024 Cochrane review concluded there is not enough evidence to support routine use of grafts for transvaginal repairs. Summary Biologic grafts can be considered in certain cases. There continues to be a need for finding the ideal “graft-patient” combination. The field particularly needs more robust research in the recurrent POP patient population.