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Pelvic Mesh: the Good, the Bad, & the Ugly

Chances are you are reading this article because you have seen the T.V. commercials raising awareness of the complications of “pelvic mesh.” Personally, I don’t recall the last time I watched 15 minutes of daytime TV without coming across such commercials. So, what is pelvic mesh? Why are they used in the pelvis? What complications are being spoken of? What should you know if you have had pelvic mesh?

Pelvic mesh refers to a pelvic reconstructive surgical procedure, commonly known as a “bladder lift,” in which the surgeon inserts a synthetic mesh-like material (most commonly under the bladder) as a means of restoring the pelvic support. When the existing pelvic supportive tissue is too damaged (usually as a result of childbirth) to be primarily used, mesh can provide added support.

Pelvic mesh was introduced in the U.S. in the early 2000s from Europe, and touted as a revolutionary minimally invasive surgical procedure to correct female pelvic prolapse (a medical term referring to herniation of the pelvic organs such as the bladder, uterus or rectum). In contrast to traditional pelvic reconstructive surgery where there is a 20-30% chance of recurrence of the prolapse requiring additional surgery, pelvic mesh was thought to provide a much needed prolonged longevity and simplicity to the repair. The preliminary published results were promising and the procedure received widespread adoption in the medical community worldwide.

A few hundred thousand pelvic mesh procedures later, reports of complications such as pain, bleeding, mesh rejection, and damage to the surrounding organs surfaced. Advocates of pelvic mesh said the source of these complications was due to inadequate training of the novice surgeons, rather than a design flaw of the mesh.

Toward the end of 2000s, the results of well-conducted research studies by expert surgeons were published. Their findings shocked the medical community and grabbed the attention of the FDA. It was shown that there could be up to 12% rate of complications within the first 12-24 months after pelvic mesh—a much higher rate than what was once presumed to be only 2-3%.

Ongoing pelvic pain, multiple failed surgeries, and ruined sexual lives left thousands of women devastated. The legal community took notice, and the affected patients, deservedly and understandably, sought financial compensation for their pain and suffering.

Today, pelvic mesh is placed cautiously in the selected few where the benefits are thought to clearly outweigh potential risks. Patients who have had pelvic mesh inserted a few years ago, who have not had any adverse effects, should continue to do well for years to come. However, there is always a small risk of mesh rejection and pain developing over time. It is, therefore, important to monitor for such symptoms with annual follow up visits. Should complications arise, it is important for patients to realize that, in the vast majority of cases, mesh can be removed successfully with excellent outcome.

It is very important not to confuse vaginal slings (also composed of mesh material), which is surgically placed for urinary incontinence, with pelvic mesh. The safety of vaginal slings has been well substantiated since their introduction in 1996. Slings are considered standard of care worldwide for the surgical management of urinary incontinence. As in any surgical procedure, slings are associated with 2-3% rate of complications.

Published in Buffalo Healthy Living Magazine, July 2014