What You Should Know About Transvaginal Mesh

Medically reviewed by Suzanne Falck MD FACP on November 1, 2016Written by Ann Pietrangelo

What is transvaginal mesh?

Surgical mesh is routinely used to reinforce tissue that has become weak or damaged. These medical products are made from animal tissue or synthetic materials. They are meant to be permanent implants.

Read on to learn what conditions transvaginal mesh can treat and what you need to ask your doctor before having the surgery.

Why would I need transvaginal mesh?

Surgical mesh is designed to offer support where tissue has become weak. Transvaginal mesh is surgically inserted through an incision in the vagina. It’s used mainly to treat stress urinary incontinence (SUI) or pelvic organ prolapse (POP).

Stress urinary incontinence (SUI)

SUI is a condition that causes unintentional urine leakage due to stress on the bladder. Certain physical activities, such as lifting something or standing up from a seated position, can cause urine to leak. Even something as simple as coughing, sneezing, or laughing can cause this.

Transvaginal mesh is used as a net or sling to support the neck of the bladder or urethra. The procedure is also called midurethral sling or mesh sling.

Pelvic organ prolapse (POP)

POP is a condition in which pelvic muscles and tissue are stretched or weakened. The muscles can no longer support the bladder, uterus, or bowel. It’s a serious medical problem that can cause pelvic organs to drop and protrude into the vagina.

Symptoms include:

  • pain during intercourse
  • pelvic pressure
  • lower back pain
  • urinary dysfunction
  • constipation

How is transvaginal mesh used?

Transvaginal mesh was first used for abdominal repair of POP in the 1990s.

It came into use for transvaginal repair of POP in 2002 in an effort to lower the POP relapse rate following conventional surgery.

The surgical mesh is inserted between the vagina and bladder or rectum, and attached to ligaments to reinforce the vaginal wall.

In time, the body’s own tissue grows over the mesh.

What are the potential complications?

There’s a risk to any surgery, including an adverse reaction to anesthesia or infection at the surgical site.

Side effects may be related to the surgery or to problems with the mesh that occur after the procedure. Complications are most likely to happen within three to six months following insertion of the mesh.

Potential side effects of transvaginal mesh surgery for SUI include pain, infection, and mesh erosion. Long-term side effects following this procedure are rare.

When used to treat POP, transvaginal mesh surgery is more complicated. The risk of serious complications is higher and may include:

  • mesh protruding from the vaginal opening
  • mesh eroding into surrounding tissues
  • organ or blood vessel perforation
  • infection
Side effects of transvaginal mesh surgery for SUISide effects of transvaginal mesh surgery for POP
painmesh protruding from vaginal opening
mesh erosionmesh eroding into surrounding tissues
infectioninfection
organ or blood vessel perforation

Signs and symptoms of surgical complications include:

  • severe or chronic pelvic, buttock, or groin pain
  • pain and pressure during intercourse
  • urinary problems
  • bleeding
  • abnormal vaginal discharge

The risk factors for these complications are not clear.

FDA warnings and class action lawsuits

Due to thousands of reports of side effects, the U.S. Food and Drug Administration (FDA) issued warnings for transvaginal mesh in 2008 and again in 2011.

There were reports of bowel, bladder, and blood vessel perforation during insertion. Mesh erosion, pain, and vaginal scarring following the surgery have led to prolonged quality-of-life issues for some women.

In January 2016, the FDA issued an order to reclassify transvaginal mesh from moderate-risk (class II) medical devices to high-risk (class III) devices. Another order requires pre-market approval supporting safety and effectiveness of surgical mesh for transvaginal repair of POP. These orders do not apply to mesh used for transabdominal repair of POP or for treatment of SUI.

Complications from the use of transvaginal mesh have resulted in numerous class action lawsuits.

When to see your doctor for follow-up care

Before you have the surgery, schedule a preoperative appointment with your doctor to know what to expect after the surgery. During your postoperative appointment, your doctor can make sure you are recovering as expected. Be sure to report all side effects right away.

Your doctor will begin your postoperative appointment by noting your symptoms and performing a pelvic examination. Based on these findings, additional tests, such as blood tests and urinalysis, may be ordered.

Treatment to correct these problems sometimes involves surgery to remove part or all of the mesh and make repairs. Tissue grows around and into the mesh, so removing all of it is complicated and can’t always be safely accomplished. The attempt can result in damage to surrounding tissue or organs.

You might also need medication to treat pain and infection.

About 30 percent of women who have surgery for POP will need a related surgery during their lifetime.

Complications from the SUI procedure are usually easier to remedy.

Outlook

Transvaginal mesh surgery is often successful. Some women heal well and enjoy a full recovery.

Those who don’t may experience disabling or permanent health problems. These may include chronic pain, urinary problems, and painful intercourse.

If you see a new doctor, be sure to report that you have surgical mesh.

What to ask before surgery

When considering any surgery, make sure you understand what you can reasonably expect. Tell your doctor about all your medical conditions and medications.

Your doctor should be open to questions and allow time to discuss the procedure and its aftereffects.

Here are some questions you should bring up:

  • Have we exhausted all nonsurgical treatment methods?
  • Am I a candidate for transabdominal repair?
  • Can the problem be surgically repaired without using mesh?
  • What are the possible benefits of transvaginal mesh for my condition?
  • What are the potential risks?
  • Are you experienced in this procedure?
  • How long will my recovery take? When can I return to my normal activities?
  • What side effects should I look for, and when should I seek medical care?
  • If I do have complications, what remedies will be available?

A reputable surgeon will have no objection if you want to seek a second opinion.

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