Surgical mesh used in transvaginal surgeries was initially designed for use in correcting abdominal hernias. It wasn’t until recently that the manufacturers began selling surgical mesh products that are inserted vaginally in order to treat pelvic organ prolapse and incontinence in women. The mesh provides extra support when the damaged and/or weakened tissue is repaired. The most common mesh devices used are made either from animal tissues or synthetic materials.
HOW SURGICAL MESH IS USED TO TREAT DISORDERS IN THE PELVIC FLOOR
Pelvic organ prolapse (POP) – When the muscles and ligaments that support the pelvic organs weaken, the organs can slip out of place or prolapse into the vagina. Mesh is implanted to reinforce the weakened vaginal wall. Surgery to implant the mesh can either be done transabdominally (through the abdomen) or transvaginally (through the vagina).
Stress urinary incontinence (SUI) – Stress urinary incontinence is loss of urine unintentionally due to activity or physical movement. Examples are, sneezing, running, coughing, or heavy lifting, or anything that puts a stress on the bladder. With SUIs, surgical mesh is implanted through the vagina in order to support the bladder neck or urethra, which is known as a mesh sling procedure or midurethral sling.
SAFETY CONCERNS ABOUT THE USE OF SURGICAL MESH TO TREAT PELVIC FLOOR DISORDERS
Each of the two mesh procedures, POP and SUI, come with its own benefits and risks. The Food and Drug Administration in 2008 warned about the potentially serious complications associated with transvaginal mesh placed through the vagina to treat these procedures. Three years later, in 2011, the FDA released a statement saying that serious complications associated with the transvaginal mesh to repair pelvic organ prolapse (POP) is not rare, that the use of transvaginal repair with the mesh might expose women to a greater risk.
Surgical mesh used for transvaginal repair of pelvic organ prolapse (POP) can cause complications such as pain, infection, mesh erosion, pain during sex, urinary problems, and organ perforation, which may require more surgery to treat.
When stress urinary incontinence (SUI) is treated with a mesh sling complications can also occur, such as infection, pain, and mesh erosion. Research has suggested that the complications are less frequent and less severe than complications associated with transvaginal mesh repair of pelvic organ prolapse (POP) and rarely require additional treatment, which includes surgery.
TRANSVAGINAL MESH AND HYSTERECTOMY
According to the CDC (Centers for Disease Control) 20 million women in the U.S. have had a hysterectomy and about 600,000 women have the surgery each year. A hysterectomy (the removal of the uterus) is the second most common major procedure in women who are still in their reproductive years. This is only surpassed by the caesarean section.
Hysterectomies are sometimes performed in order to correct organ prolapse. However, those women who undergo the procedure are also at an increased risk of suffering a recurrence. This risk increases if the reason for they hysterectomy was because of uterine prolapse. Doctors may choose to insert a medical device called transvaginal mesh to secure the pelvic organs and reinforce the pelvic floor tissues when a hysterectomy is performed to repair a prolapse. More than 300,000 surgeries to repair prolapse were performed in 2010; of those surgeries, 75,000 used transvaginal mesh implants, which have since proven to be problematic in many women.
COMPLICATIONS OF MESH AFTER HYSTERECTOMY
Due to the high rates of complications that have been associated with the use of transvaginal mesh , this has prompted the U.S. Food and Drug Administration (FDA) to release a safety report in July 2011. According to the report the most common complication is mesh erosion through the vagina, which is also referred to as exposure, extrusion, or protrusion. Infection, pain, bleeding, and painful sex are also listed as common complications as are urinary dysfunction and organ perforation. Mesh shrinkage is another serious issue that has been identified by the FDA. This can cause scarring, vaginal shortening, intense pain, and sexual dysfunction, neuromuscular problems and recurrent prolapse. More surgery is required to resolve many of these complications. Some women have had to undergo multiple procedures in order to fix these complications and in some instances even multiple surgeries have been unable to fix the damage. Because of these complications and the damage the transvaginal mesh procedures have demonstrated, the FDA has advised that since the procedures have not demonstrated better clinical results than the traditional non-mesh surgeries, that surgeons and patients should consider safer alternatives to transvaginal mesh surgeries.
QUESTIONS TO ASK BEFORE SEEKING TRANSVAGINAL MESH TREATMENT
If you have a pelvic floor disorder and are considering treatment involving transvaginal mesh, make sure your health provider explains to you all of your options, including the possible risks and benefits. Pay particular attention to the risks associated with surgical repair with pelvic organ prolapse (POP), such as the possible need for additional surgery due to the transvaginal mesh related complications. If you have experienced complications and/or side effects from your transvaginal mesh get help now.