Vaginal Mesh in Surgery for Vaginal Prolapse FAQ

Posted by on Jan 14, 2013 in Vaginal Prolapse | No Comments

What is vaginal mesh?

Vaginal mesh is an artificial or biologic material which is used during vaginal surgery in the repair of women who have prolapse, or loss of support, of their pelvic organs. It is mainly used when the uterus or upper vagina is part of the prolapse.

Why would vaginal mesh be used?

The main purpose for using vaginal mesh is  to increase the chance of the procedure working. Another major advantage is that mesh procedures do not require hysterectomy, & may be much less surgery to go through. This is particularly useful in older & less healthy women.  Research has shown that women with prolapse often have a weakness in the strength of the tissues that support their vagina & uterus. These tissues are often injured in the process of pregnancy & delivery, & the damage increases with time. Surgery does not make the tissues stronger, & “tacking” weak tissues together often fails. General surgeons learned that hernias occur due to a similar weakness in the abdominal wall tissues, & if they try to use the patient’s own tissue to fix the hernia it fails. They have been using mesh successfully for hernias for decades.

What problems can occur after a vaginal mesh procedure?

The main problem with any mesh is chance that the skin over the mesh will not heal & the mesh will become exposed. If this happens in the vagina it can cause discharge, spotting, & pain with intercourse. Pain during sex is more common after vaginal mesh procedures in younger women. Recent research has show that the mesh makes the vagina stiffer & less flexible, particularly when it is used between the bladder & vagina. It is difficult to say how often this happens as not all cases are reported. There have been over 250,000 mesh procedures performed in the US, & around 2500 cases of complications. Many studies have shown that the experience of the surgeon is important with higher-volume surgeons reporting problem rates of 2-4%, & less experienced surgeons with rates of 16% or higher.

Do we use vaginal mesh?

No. We no longer use vaginal mesh for the treatment of vaginal prolapse. We made this decision based on increasing reports of the mesh not healing & becoming exposed in the vagina. There are biological meshes or grafts which are used vaginally, but many studies have shown that they also can have problems related to healing or scarring.

Have vaginal meshes been recalled? 

No. In June of 2011 the FDA issued a warning that complications after vaginal mesh were “not rare,” & that patients should be counseled about the possibility of potential problems. The FDA now requires the companies that make mesh to  perform studies for 3 years to demonstrate that their mesh is safe & effective. We feel that those studies should have been done years ago & that the FDA has been too lax in allowing new products on the market. Some companies have decided it is not worth it & have taken their products off the market.

What are the alternatives to vaginal mesh?

There are many procedures which use the patient’s own tissues to repair prolapse. We have performed thousands of these procedures over the last 25 years.

Is a vaginal sling the same as vaginal mesh?

No. Although many of the vaginal mesh lawyer commercials us the word “sling,” the vaginal sling used to treat urinary leakage is completely different from the vaginal mesh, & is not the focus of the FDA concerns.  Millions of slings have been performed worldwide over the last 15 years with very low rates of problems. We have performed over 3000 in the last 10 years with extremely rare & minor problems.

An editorial in November 2012  concluded that synthetic slings are safe, effective, & remain the standard of care for the treatment of  women suffering from stress urinary incontinence.

http://www.obgmanagement.com/article_pages.asp?aid=10858

Here is a link to recent FDA comments about the use of mesh in urogynecologic surgery:

http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/UroGynSurgicalMesh/default.htm

 

What about abdominal mesh?

Like slings, synthetic mesh used in the abdominal repair of prolapse is completely different from the vaginal mesh, & is not the subject of FDA concerns. The use of abdominal mesh for the treatment of upper vaginal prolapse (sacral colpopexy) was developed in the 1970’s, & it remains the “Gold Standard” in terms of safety & holding up. It is a much more complicated procedure than a vaginal mesh procedure because it is performed abdominally. The risk of the mesh becoming exposed vaginally is extremely rare (less than 1%). We have performed over 1000 of these procedures, & we perform the procedure laparoscopically (“keyhole surgery”) to avoid a large abdominal incision. If we leave the lowest part of the uterus (the cervix) in place the risk of mesh exposure is as close to zero as possible.

What is the best procedure for my prolapse?

Our goal is to provide you with the safest & most effective procedure to fix your prolapse, with the least risks & best recovery. The choice of procedures depends on your age, activity level, health, & how bad your prolapse is. If your prolapse does not involve your uterus or upper vagina, the surgery is done as an outpatient using your own tissues. If your uterus or upper vagina are part of your prolapse, that is were we have to make a decision about such things as a vaginal or abdominal approach, or whether a hysterectomy or abdominal mesh would be useful. Ultimately, it will be your choice as to what you are most comfortable with. We are experienced in all of the options, & our job is answer your questions.

Click here to read the full committee opinion about vaginal mesh.

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