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VAginal mesh for pelvic prolapse repair

 

On July 13, 2011, the FDA released a safety communication on the use of synthetic vaginal mesh (also known as transvaginal mesh or pelvic mesh) to repair pelvic organ prolapse. Pelvic organ prolapse (POP) is a weakening of the pelvic organ tissues, resulting in "sagging" or dropping of the bladder, uterus, or rectum into the vaginal opening. These bulging tissues can often be felt through the opening of the vagina. POP can be caused by stretching that occurs during childbirth. It is more common after a hysterectomy, after menopause, and with increased age. Surgical mesh is a permanent medical material that is implanted in the vagina or the abdomen to strengthen the vaginal wall and support the pelvic organs. The FDA, American Urological Association (AUA) and Urology Care Foundation would like patients to know that treating POP with surgical placement of mesh may cause complications for some patients.

Please understand that not all patients treated with synthetic vaginal mesh will have complications. There is no reason to remove mesh if there is a good outcome and no complications. Also, many of these complications may occur even if mesh is not used for POP repair. However, if you underwent POP treatment with synthetic mesh, there are warning signs of which you need to be aware:

  • Erosion: The most common complication experienced by patients, erosion occurs when mesh materials protrude into the vagina. This may cause vaginal bleeding or discharge. Also, male sexual partners may experience irritation to the penis during sexual intercourse due to the presence of eroded mesh materials.
  • Sexual dysfunction: Pain during sexual intercourse.
  • Urinary tract infections: Frequent bladder infections could be due to the presence of mesh within the urinary tract.
  • Pain: Pelvic or groin pain.


If you are experiencing any of these problems, please talk to your surgeon. While one possible solution is to remove the mesh materials surgically, non-surgical interventions may also correct the problem.

If you are not experiencing any of these symptoms, you may continue with your routine scheduled care. However, it is very important to be aware of the possible complications and carefully follow postoperative instructions, see your physician for scheduled check-ups, and contact your physician if you should begin to experience any problems.

If you have been diagnosed with pelvic organ prolapse and are considering surgery, it is important to discuss with your physician the type of surgical technique and materials to be used. Some suggested questions to ask your doctor include:

  • What type of mesh will be implanted?
  • How will the mesh be implanted (transvaginally or abdominally)?
  • Are there other alternative surgical techniques available?
  • How many of these procedures has the surgeon performed?
  • What complications have his/her patients experienced and how often?


To see the American Urological Association’s clinical position statements click here.

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