Vaginal 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 “vaginal 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? And, what should you know if you have had pelvic mesh?

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

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

A few hundred thousand mesh procedures later, reports of complications surfaced. Proponents of the mesh argued these complications were due to inadequate training of the novice surgeons, rather than a design flaw.

Toward the end of the 2000s, researchers published the results of well-done studies. Their findings shocked the medical community and grabbed the attention of the FDA. The findings showed that there was up to 12% rate of complications within the first 12-24 months—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, the FDA has recalled all vaginal mesh devices and they are no longer available in the market. 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, which is surgically placed for urinary incontinence with pelvic mesh. Vaginal slings are safe with low complications rate. Slings are considered standard of care worldwide for the surgical management of urinary incontinence. Fore more information on vaginal slings read ACOG.

Published in Buffalo Healthy Living Magazine, July 2014