Transvaginal mesh was intended to permanently fix pelvic organ prolapse conditions that typically occur in older women after childbirth, a hysterectomy or menopause.
Used to treat pelvic prolapse and stress urinary imcontinence.
The process involves a hammock-like piece of synthetic mesh surgically implanted transvaginally, to support the prolapsed organs.
The use of vaginal mesh for anterior vaginal wall prolapse is associated with an increased risk for repeat surgery for mesh removal.
Dr. JM Wu and colleagues analyzed 27,809 women who underwent anterior colporrhaphy: 6871 with vaginal mesh and 20,938 with native tissue.
The primary analysis looked at long-term outcomes.
Women in the vaginal mesh group were older than those in the native-tissue group (59 vs 55 years, and were more likely to have a concurrent/recent sling (70.6% vs 62.4%, and were less likely to have a concurrent hysterectomy (18.4% vs 39.3%.
The 5-year risk for any repeat surgery was higher in the vaginal-mesh group than in the native-tissue group 15.2% vs 9.8%.
The mesh removal/revision rate at 5 years was 5.9%, but the risk for recurrent prolapse was similar in the vaginal-mesh and native-tissue groups.
Vaginal mesh was used primarily because of the potentially lower risk for recurrent prolapse.
Transvaginal mesh has several well known complications such as organ perforation and erosion in women nationwide.
Some of the less severe problems include constipation and urinary incontinence.
Transvaginal mesh is used in several types of surgery.
The most common problem associated with vaginal mesh implants is transvaginal mesh erosion, also called mesh extrusions.
It occurs when the synthetic mesh cuts through the vaginal lining and nearby organs.
Mesh erosion can cause organ perforation, infection, bleeding, pain during intercourse and urinary problems.
Some patients have developed antibiotic resistant infections.
Other complications include recurrent prolapses, neuromuscular problems, vaginal scarring, shortening and emotional problems as a result of the defective mesh.
Mesh repairs of pelvic prolapses often do not fix the symptoms of prolapse or improve the patient’s quality of life over non-mesh repairs.
Transvaginal mesh has a high rate of revision surgeries.
With more than 75,000 transvaginal mesh prolapse surgeries were performed in 2010 alone, and more than 10 percent failed.
Some feel that mesh complications are inevitable and that revision or replacement is necessary.
A surgical revision, or surgical removal is often painful and difficult because tissues grow in and around the mesh.
Revision surgery may need to be performed several times before all the mesh pieces have been removed.
The US Food and Drug Administration (FDA) ordered the manufacturers of vaginal mesh products to stop selling and distributing their products in the US.(4/19).
The three vaginal mesh devices available in the United States are Boston Scientific’s Uphold LITE and Xenform, and Coloplast’s Restorelle DirectFix Anterior.
There has been a significant increase in the number of reported adverse events associated with the use of surgical mesh for transvaginal repair of pelvic organ prolapse.
Mesh manufacturers could not demonstrate that surgical mesh should be superior to native tissue repair at 36 months and the safety outcomes for surgical mesh should be comparable to native tissue repair.