Surgical Mesh: Use and Complications in Women
What is surgical mesh?
Surgical mesh is a screen-like material that is used as a reinforcement for tissue or bone. It can be made of synthetic polymers or biopolymers.
Materials used for surgical mesh include:
- Non-absorbable synthetic polymers (polypropylene)
- Absorbable synthetic polymers (polyglycolic acid or polycaprolactone)
- Biologic (acellular collagen sourced from cows or pigs)
- Composite (a combination of any of the three previous materials)
Most surgical mesh devices used for female pelvic reconstructive surgery are made of non-absorbable synthetic polypropylene.
For what female urologic procedures is surgical mesh typically used?
Surgical mesh is used to help repair pelvic organ prolapse (POP) and stress urinary incontinence (SUI) in women.
In pelvic organ prolapse, the pelvic organs may shift downward and bulge out of the vagina. This occurs in women whose pelvic floor muscles and tissue are too weak to hold the organs in place. Pelvic organs that may be subject to a prolapse include the bladder, uterus, rectum, vagina, and urethra. Factors that can increase the chance of POP in women include pregnancy, childbirth, and aging. The bladder is most often involved in pelvic organ prolapse. Prolapse of the bladder is called cystocele.
In stress urinary incontinence certain activities that increase pressure on the abdomen can cause urine to leak. These activities can include coughing, laughing, sneezing, or exercising. The weakening of the pelvic muscles and tissues causes the bladder neck to move downward. As with pelvic organ prolapse, factors such as pregnancy, childbirth, and aging may cause the pelvic muscles to stretch or weaken.
How is surgical mesh used to repair pelvic organ prolapse and stress urinary incontinence?
Surgical mesh is permanently implanted to reinforce the vaginal wall for POP repair or support the urethra or bladder neck for the repair of SUI.
There are three main surgical procedures performed using surgical mesh:
- Transvaginal insertion of mesh to treat POP
- Transabdominal insertion of mesh to treat POP
- Mesh sling to treat SUI: A multi-incision sling procedure may be performed in which three incisions are made. In the retropubic procedure, two very small incisions are made above the pubic bone and a third incision is made in the vagina. In the transobturator procedure, two very small incisions are made in the groin and thigh and one incision is made in the vagina. A mini-sling procedure, in which a shorter piece of surgical mesh is inserted, requires only one incision.
POP can also be repaired without surgical mesh. In that case, the incisions are made in the vagina, and they are closed with sutures only.
Surgeries in which mesh slings are used have been successful in most cases and in about 70 to 80% of cases within one year following surgery.
How common is the use of surgical mesh to repair pelvic organ prolapse and stress urinary incontinence?
About 300,000 women in the U.S. underwent surgery to repair POP in 2010. Surgical mesh was used in about one out of three procedures. About 250,000 women in the U.S. underwent surgery to repair SUI in 2010, with mesh placement being used in over 80% of the procedures. The mesh sling has been the most widely studied procedure for stress incontinence in the history of stress incontinence surgery. All of the major urologic and gynecologic societies have supported its continued use as of 2016.
What are some complications associated with surgical mesh devices for pelvic organ prolapse and stress urinary incontinence repair?
- Vaginal mesh erosion: This is the most common complication following the use of surgical mesh devices to repair pelvic organ prolapse and stress urinary incontinence. Non-absorbable synthetic surgical mesh, such as that made of polypropylene or polyester, can break down or wear away over time. Part of the mesh may become exposed or protrude through the vagina
- Vaginal mesh contraction: Shortening or tightening of the mesh over time can cause vaginal shortening, tightening, or pain
- Pain during sexual intercourse
- Urinary problems
- Tearing of organs
- Pelvic organ prolapse that returns
- Emotional problems
Surgery may be needed to remove the mesh or correct other complications as they can occur at times after mesh placement, although the overall incidence is rare. Over 50% of women who experienced erosion with non-absorbable synthetic mesh needed to have the mesh surgically removed. Some patients required two or more operations after the mesh was removed.
The average rate of mesh erosion following SUI surgery is about 2% after one year. However, erosion may sometimes be treated with vaginal cream or by removing part of the exposed mesh in a doctor’s office. In other cases, the mesh must be surgically removed.
Negative effects following surgery can be life-changing for some women. Pain may persist even after the mesh is removed.
What are some recommendations for women considering surgery for pelvic organ prolapse?
Consider various options regarding POP treatment, including non-surgical methods and suture-based methods, as they have been shown to be very effective in the long term without some of the complications associated with mesh use.
Surgery may be performed with or without the use of surgical mesh. Use of mesh may increase the risk of subsequent surgeries due to complications involving the mesh. In a small percentage of patients, additional surgeries might not solve all medical problems. You should consult an expert in this area as experience does help in determining the best course of management.
What are the recommendations for me if I have undergone pelvic reconstructive surgery?
You should follow up with routine check-ups and pelvic examinations each year. Let your healthcare provider know if you have symptoms such as vaginal bleeding or discharge, pelvic or groin pain, or pain during sexual intercourse. Tell your doctor about any surgical mesh implants if you plan to have surgery to treat a related condition or another type of operation. Talk to him or her if you have any questions or concerns.