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Q: I’ve heard a lot of debate about vaginal mesh. Should I be concerned about this procedure?
A: The short answer is probably not, but there is more to the story. It’s important to know all of the details and consult with your physician before making a decision.
First, if you have already had the procedure and are not having problems, you do not have to worry about the mesh.
Second, it’s important to distinguish between a bladder sling or more accurately, urethral sling, which is different from vaginal mesh. Both are made of the same material, polypropylene, but the sling is just a small ribbon of material that is placed under the urethra – the tube that drains the bladder – and is not associated with the same problems as the vaginal mesh. The urethral sling has proven to be a very safe and effective method for treating urinary incontinence (leakage) and it requires minimal surgery.
Vaginal mesh is a sheet of synthetic material that is used to help with pelvic prolapse. It has also been shown to be effective in providing vaginal support at the top (vaginal apex), anteriorly (cystocele) and posteriorly (rectocele).
Unfortunately, mesh is associated with unique problems not seen with traditional surgery using natural tissue including erosions into organs and exposure in the vagina. These complications can be minimized by good technique but not completely eliminated. Keep in mind, mesh is permanent and may prove difficult to remove even with additional surgery.
In July 2011, the FDA released a statement advising the public of potential problems and encouraged physicians and patients to review benefits, risks and alternatives to mesh placement. The FDA also concluded the evidence does not show mesh to be superior over natural tissue for posterior and apical support. Mesh does provide superior anatomic anterior support but the patient may not feel the difference.
The benefits of mesh include longer-lasting support and may be an appropriate choice in certain situations. Treatment options should be discussed with a physician who regularly performs prolapse surgery.
Having performed pelvic surgery for more than 25 years, I have had good success even before mesh was available. I have used mesh successfully but I believe it should be limited to cystocele repair because of inherent weakness anteriorly and suggest it be used perhaps only after a failed attempt with natural tissue. Mesh may also be a more appropriate option for older women who are no longer sexually active, due to some reported concerns about pain with intercourse after placement.
While mesh could be the culprit, there are many causes of pelvic pain that are unrelated to mesh. The only way to find out if mesh is responsible for pelvic pain is to be examined by a physician familiar with mesh placement.
Donald Rubino, MD, FACOG, is a board-certified obstetrician and gynecologist at Newton Medical Center.