If you're a woman who has a pelvic floor disorder, you've likely heard of treatments involving transvaginal mesh. However, reports about complications might have you confused or hesitant to seek treatment. Understand the concerns about transvaginal mesh and what they might mean for you.
What is surgical mesh?
Surgical mesh is a medical device that is used to provide extra support when repairing weakened or damaged tissue. Most surgical mesh devices are made from synthetic materials or animal tissue.
How is surgical mesh used to treat pelvic floor disorders?
Surgical mesh can be used to treat:
- Pelvic organ prolapse (POP). When the muscles and ligaments supporting a woman's pelvic organs weaken, the pelvic organs can slip out of place (prolapse). To treat POP, surgical mesh can be implanted to reinforce the weakened vaginal wall. Surgery can be done through the abdomen (transabdominal) or through the vagina (transvaginal).
- Stress urinary incontinence (SUI). This is the unintentional loss of urine due to a physical movement or activity — such as coughing, sneezing, running or heavy lifting — that puts pressure (stress) on your bladder. Surgical mesh can be implanted through the vagina to support the urethra or bladder neck. This is known as a midurethral sling or a mesh sling procedure.
What are the safety concerns about use of surgical mesh to treat pelvic floor disorders?
Each type of mesh procedure carries its own risks and benefits.
In 2008, the Food and Drug Administration (FDA) warned of potentially serious complications associated with surgical mesh placed through the vagina to treat POP and SUI. Then, in 2016, the FDA changed the classification of surgical mesh to repair POP transvaginally from a moderate-risk device to a high-risk device.
Research has shown that surgical mesh for transvaginal repair of POP can cause complications such as mesh erosion, pain, infection, bleeding, pain during sex, organ perforation and urinary problems. Many of these complications require additional treatment, including surgery.
Treating SUI with a mesh sling also can cause complications, including mesh erosion, infection and pain. However, research suggests that the complications are infrequent and less severe than are complications associated with surgical mesh for transvaginal repair of POP, and rarely require follow-up surgery.
What questions should I ask before seeking a mesh treatment for a pelvic floor disorder?
If you're considering treatment for a pelvic floor disorder that involves surgical mesh, be sure to have your health care provider explain all of your options, as well as their possible risks and benefits. In particular, be aware of the risks associated with surgical mesh for transvaginal repair of POP, such as the need for additional surgery due to mesh-related complications.