What is synthetic mesh?
Mesh is a net-like sheet made using a suture material synthetic polymer called polypropylene. Biologic grafts are sheets of connective tissues from animal or donor sources. Synthetic and biologic grafts can be inserted into the pelvis, usually under the vaginal skin to support the pelvic organs and treat stress urinary incontinence and pelvic organ prolapse.
What are Mesh Complications?
Mesh surgery is performed using minimally invasive surgical techniques. As with any surgery, there are risks and complications that may occur. With mesh surgery, complications can include mesh extrusion, where the mesh migrates into the vagina or bladder, infection, vaginal complications such as discharge or bleeding, urinary complications such as voiding dysfunction, bowel complications such as irregular bowel movements, and pelvic pain.
At our center, we rarely find an indication to use an implant sheet vaginally, but frequently see patients referred with complications from previously implanted mesh or grafts. We have expertise in management of vaginal, rectal or bladder erosions, mesh contraction and pain, and other recognized complications.
How are Mesh Complications Managed?
The complications that arise following mesh surgery can be managed through corrective procedures, also called mesh revision surgery. The different approaches to manage mesh complications include:
- Partial or complete removal of the mesh through vaginal, abdominal, or laparoscopic surgery.
- Trimming the exposed mesh that has migrated but leaving the rest intact.
- Administration of vaginal estrogen, systemic or local antibiotics to treat pain and infection.
- Vaginal reconstruction or vaginoplasty: This is a surgical procedure to normalize vaginal elasticity and support when excessive tightness and vaginal/sexual pain has resulted from implanted mesh.
- Pain management through counseling, local anesthetic, physical therapy, analgesics, and injection of botulinum toxin.
- Transurethral excision: This is a surgical procedure performed in women who have undergone a sling procedure and involves excision of a section of mesh which may have eroded into the urethra.
Success following Surgical Treatment of Mesh Complications
Vaginal and transurethral mesh excision techniques are typically safe and successful. They can provide relief from symptoms of mesh complications and improve the quality of life in most patients. The corrective procedures should be performed by a trained urologynecologist through gentle tissue dissection. You should go for regular follow-ups after your surgery to ensure a smooth recovery and to make sure any persistent pain or problems are addressed until your symptoms are addressed.
To learn more about the various approaches for the management of mesh complications, visit an expert who will explain about the specific options that are best suited to you. At our center, we have cared for many women with mesh complications and have published our results and instructional videos for other surgeons.