To mesh or not to mesh

We are in the midst of an increasingly acrimonious discussion regarding the use of mesh in pelvic reconstructive surgery. Modern mesh kits, aggressively marketed by biotech companies, have become widespread. At times, they are used inappropriately, and significant complications such as pain syndromes and erosion are not uncommon. While conventional alternatives such as sacrospinous colpopexy and Burch colposuspension are not without their problems either, the discussion surrounding mesh use has a character never encountered before in urogynaecology. Many colleagues feel that the resolution of this conflict may be found in large randomised controlled trials such as the PROSPECT trial currently being planned in the UK. I feel that such a trial may well do more harm than good, unless certain precautions are taken. In this opinion piece I'll try and explain why.