Advertisements on television and billboards, website warnings, and telephone calls from vague clearinghouses are some of the ways many have been exposed to the word “mesh” in pelvic surgery. Often women delay getting evaluated for their pelvic floor disorder due to the negative media and their concern that mesh may be used in their treatment.
What is mesh? Can I avoid mesh in surgery? are frequently asked questions in my practice.
For any patient interested in surgery, a discussion in regards to the pros and cons of mesh is warranted.
What is Mesh?
Mesh is a synthetic graft used to augment surgical repair. General surgeons have been using mesh for hernia repairs for many years to decrease the rate of recurrent hernias. Similarly, pelvic surgeons started incorporating the use of mesh to make repairs more durable.
Unfortunately, using additional graft in the pelvic and vaginal areas pose some risks for complications that mesh in hernia repair did not.
Has Mesh Changed?
Not all mesh products are the same. These synthetic grafts vary by the type of materials used and how they are woven together. Some mesh that were used in the past used heavier materials which led to more scarring and pain into the vagina. Others were woven more closely together leading to higher risk for infection and rejection from the tissues.
Overall, the types of mesh used in pelvic surgery have evolved to be more lightweight with a very low risk of infection.
Are There Still Risks with Mesh Use?
Yes. The benefits of durability with the use of mesh have to be weighed against the potential risks, and the risks vary depending on where and how the mesh is used. Mesh is commonly used for the treatment of stress urinary incontinence and pelvic organ prolapse. In prolapse, it may be used abdominally (including robotically or laparoscopically) or vaginally.
The most common risk is mesh exposure in the vagina where the synthetic material can be seen or felt in the vagina. Patients with mesh exposure may have bleeding, pain with sex, or no symptoms at all. The following rates have been associated with various types of procedures:
- 1-5% risk for stress urinary incontinence procedures
- 3-8% risk if mesh introduced through the abdomen, robotically or laparoscopically
- 4-15% risk if the mesh is placed through the vagina
A mesh erosion may be minor and managed effectively in the office or it may require surgery.
Other risks of mesh are also risks of non-mesh pelvic surgery which include new urinary symptoms, vaginal scarring, recurrent prolapse, or damage to surrounding organs.
Scientific studies have shown that the benefits of the use of mesh may outweigh its risks in the following procedures:
- Mesh sling for stress urinary incontinence.
- Transabdominal mesh in sacrocolpopexy for pelvic organ prolapse
- Transvaginal mesh for bladder prolapse.
Get Evaluated by a Urogynecologist
If you suffer from a pelvic floor disorder, whether it be prolapse or urinary leakage, there are options for you! Get evaluated by a urogynecologist who will discuss non- surgical options as well as surgical options.
If surgery is required, a balanced view of the use of surgical mesh, including approaches with or without the use of mesh would be discussed. If you have suffered from a mesh complication, get evaluated and counseled on therapeutic options.
About Andrea Crane, MD
Dr. Andrea Crane is a board certified OB/GYN and urogynecologist at WakeMed with interests in comprehensive pelvic reconstruction, da Vinci® robot-assisted sacrocolpopexy, and sacral neuromodulation.
Her training includes evaluation and treatment of childbirth trauma, advanced pelvic organ prolapse, urinary and fecal incontinence, vesicovaginal and rectovaginal fistulae, and mesh complications.