What is vaginal mesh?
Vaginal mesh kits were surgical implants used to treat conditions like pelvic organ prolapse and stress urinary incontinence (SUI). Vaginal mesh kits used in pelvic organ prolapse repair surgery were removed from use by the Food and Drug Administration (FDA) in 2019 due to complications attributed to them.
What risks and complications are associated with vaginal mesh?
While transvaginal mesh kits used in prolapse surgery have helped many women, they have also caused a lot of complications, particularly when inserted incorrectly.
Over 50% of women who experienced non-absorbable synthetic mesh erosion needed to have it surgically removed. Surgical mesh complications occurred in about 10-15% of women who had this surgical treatment.
However, the risk varies depending on the mesh type and its placement. Complications from mid-urethral sling surgery can lead to symptoms that range from mild discomfort to those indicative of severe, life-altering issues that may require additional surgeries or interventions.
What causes vaginal mesh complications?
Vaginal mesh complications can happen for several reasons. The mesh might erode into nearby tissues, such as the vaginal wall, bladder, or rectum, or it could shrink over time, causing pain and tightness.
The mesh sling can also become colonized with bacteria, leading to recurrent or persistent infections. These infections can cause pain, discharge, erosion, or scar formation. Sometimes, the body may react to the mesh as a foreign object, causing inflammation or scarring.
Certain factors may increase your risk of developing mesh complications. For example, if you had previous pelvic surgeries before the mesh placement, scar tissue may have made the placement more challenging.
How common are vaginal mesh complications?
Vaginal mesh complications are significant and vary depending on the type of procedure and study methodology.
Here’s a comprehensive overview of complication rates:
For SUI procedures, approximately 9.8% of patients experience complications either during the procedure or within 30 days or five years of the surgical procedure. The highest risk period is within the first two years after the procedure.
The most common complication rates of this sling procedure are notably higher for pelvic organ prolapse (pelvic floor) repairs:
- 15-25% overall complication rate
- Erosion rates range from 7.3-21%
- Up to one in four women may experience complications
If you are postmenopausal and not using vaginal estrogen, then your vaginal tissue may be thinner and less elastic, increasing the risk of mesh erosion.
Anything that negatively impacts your tissue healing, like smoking or having conditions like diabetes or other immunosuppressive conditions, can increase your risk of complications. Additionally, certain mesh types are inherently more likely to cause complications than others.
What are the symptoms of vaginal mesh complications?
Vaginal mesh complications can present with various symptoms that may appear within weeks or months after surgery. Here are the key symptoms to be aware of.
Pain-related symptoms of vaginal mesh complications include:
- Chronic pelvic pain
- Pain during sexual intercourse (dyspareunia) (which partners may also notice)
- Chronic pain in the buttocks and legs
- Stabbing or pricking sensations in the vagina
- Abdominal pain
Urinary issues of vaginal mesh complications include:
- Worsening incontinence
- Difficulty urinating
- Recurring urinary tract infections
- Discomfort during urination
- Stress incontinence
Vaginal symptoms of vaginal mesh complications include:
- Abnormal vaginal discharge
- Persistent vaginal bleeding unrelated to menstruation
- Mesh becoming visible or felt through the vaginal wall
- Vaginal scarring
- Vaginal prolapse
Organ-related issues include:
- Return of pelvic organ prolapse
- Bladder control problems
- Fistulas (abnormal connections between organs)
These symptoms indicate the most common complications and often require immediate medical attention, particularly if infection is suspected. The severity and combination of symptoms can vary significantly among individuals.
How are vaginal mesh complications diagnosed?
To diagnose the problem, we’ll discuss your symptoms, surgical history, and other medical history to identify any risk factors for mesh complications. If you have details from the original mesh surgery, please bring them to your consultation.
Once we have taken a history, we will do a pelvic exam to check for mesh exposure and determine if any part of the mesh has eroded through the vaginal wall or if it is causing pain in specific areas.
If we suspect the mesh has eroded into the bladder, we will perform a cystoscopy (inserting a small, flexible camera into the urethra to examine the bladder). We may also obtain imaging tests, such as an MRI, to further characterize the type of mesh implant and its location.
If we suspect the bowel may be involved, we may recommend a referral to a colorectal surgeon for an additional consultation.
These diagnostic tests help inform treatment options, namely, whether surgery is necessary and which type is best for each patient’s situation.
What is the treatment for vaginal mesh complications?
Treatment for vaginal mesh complications depends on the severity of your symptoms and the findings from the diagnostic workup. For mild cases, a conservative non-surgical treatment approach might be considered. For example, we may prescribe antibiotics for infections, topical estrogen to improve tissue health, or physical therapy to relax your pelvic floor. However, if the complications are more severe, surgery may be required to remove part or all of the mesh.
Partial mesh removal involves removing the eroded or problematic portion of the mesh while leaving the rest intact. Complete mesh removal may be indicated in certain severe cases, though this carries an increased risk and is reserved for specific circumstances.
Mesh removals are most often able to be performed through the vagina. Repairing the tissues after the mesh is removed may require reconstructive surgery. Such surgery can be complex, and potential risks include bleeding, infection, or injury to the surrounding organs.
For these reasons, it is essential to seek treatment from a physician with experience in vaginal mesh removal, such as those at Tower Urology. It is vital to remember that, in some cases, symptoms such as prolapse or incontinence may recur after mesh removal. In some cases, women may continue to experience pain even after the procedure.
If you’re experiencing any issues related to vaginal mesh complications, please don’t hesitate to reach out. We’ll work together to evaluate your symptoms, determine the best action, ensure full and proper follow-up treatment, and help you feel better. While complications can be challenging, you can find relief with the appropriate treatment and support.
Why trust Tower Urology to correct vaginal mesh complications in Los Angeles?
If you’ve had vaginal mesh surgery and are experiencing any of these degrading quality of life symptoms, please schedule an appointment a Tower Urology and let our female urogynecology specialists evaluate you.
Tower Urology’s board-certified urological team has been a leader in effectively treating women’s health concerns for over two decades, with specialists trained in all aspects of women’s health.
The advantage of Tower Urology lies in our unwavering commitment to providing world-class urologic care through advanced technology, personalized treatment plans, and a patient-centered approach. With a reputation for excellence and innovation, we deliver superior outcomes that distinguish us as leaders in urologic health.
Tower Urology is a proud affiliate of Cedars-Sinai Medical Center, ranked #1 in California and #2 nationwide by U.S. News & World Report. This partnership reflects our dedication to delivering the highest standard of urologic care alongside the best urologists in Los Angeles. Our years of experience and access to Cedars-Sinai’s world-class facilities ensure that our exceptional and innovative urological care positions Tower Urology as a leader in Southern California.
We invite you to establish a care plan with Tower Urology.
Tower Urology’s health care professionals are conveniently located for patients throughout Southern California and the Los Angeles area, including Beverly Hills, Santa Monica, West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, and Downtown Los Angeles.
Our services include treatment for pelvic organ prolapse, menopause/hormone management, chronic pelvic pain syndrome in women, shockwave therapy for pelvic pain, interstitial cystitis, lichen sclerosis and planus, urethral diverticulum, urethral stricture disease, urinary fistulas, and vaginal mesh complications.
Vaginal mesh complications FAQs
Mesh complications after prolapse surgery are relatively common, with rates varying depending on the type of procedure and mesh used. Overall, the complication rate within 5 years of mesh procedures is estimated to be 9.8%.
It’s important to note that complication rates can vary based on factors such as surgical technique, mesh type, and individual patient characteristics.
Prolapse surgery failure can be determined by the following:
- Recurrence of prolapse symptoms:
- Feeling of vaginal bulge or pressure
- Visible or palpable tissue protruding from vagina
- Anatomical changes:
- Prolapse beyond specific points (e.g., hymen)
- Detected during pelvic exam or imaging
- Need for additional treatment:
- Repeat surgery
- Use of pessary
- Persistent or worsening urinary or bowel symptoms
- Recurrence of prolapse symptoms:
If you experience these issues, consult your healthcare provider for evaluation. Remember, some women may have anatomical changes without symptoms, while others may have symptoms despite good anatomical results.
Yes, some vaginal mesh complications can be treated without surgery, depending on severity. Non-surgical options include:
- Pelvic floor physical therapy
- Vaginal estrogen cream for small exposures
- Observation for asymptomatic cases
- Medications for symptom management
- Lifestyle changes (e.g., weight loss, avoiding heavy lifting)
However, severe complications like significant mesh erosion or organ perforation usually require surgery. If non-surgical treatments are ineffective or symptoms worsen, consult a specialist to discuss surgical options.
Sources
FDA takes action to protect women’s health, orders manufacturers of surgical mesh intended for transvaginal repair of pelvic organ prolapse to stop selling all devices
https://www.fda.gov/news-events/press-announcements/fda-takes-action-protect-womens-health-orders-manufacturers-surgical-mesh-intended-transvaginal
NHS England » Mesh Oversight Group Report
https://www.england.nhs.uk/ourwork/qual-clin-lead/mesh/
Characterization of the t cell response to polypropylene mesh in women with complications
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6557122/
