The American College of Obstetricians and Gynecologists (ACOG) and the American Urogynecologic Society (AUGS) have issued updated clinical management guidelines that highlight recent systematic review evidence on the use of biologic and synthetic mesh grafts in the repair of anterior pelvic organ prolapse (POP). The joint document reviews information on the current understating of POP in women and outlines guidelines for diagnosis and management. Updated (Level A) recommendations include:

• Uterosacral and sacrospinous ligament suspension for apical POP with native tissue are equally effective surgical treatments of POP, with comparable anatomic, functional, and adverse outcomes.
• The use of synthetic mesh or biologic grafts in transvaginal repair of posterior vaginal wall prolapse does not improve outcomes.
• Compared with native tissue anterior repair, polypropylene mesh augmentation of anterior vaginal wall prolapse repair improved anatomic and some subjective outcomes but is associated with increased morbidity.