Today I had a most interesting conversation with a new patient about the merits of mesh repairs for prolapse. Her research had alarmed her that there was limited long term information available on the new mesh repairs, especially the new kits that place the mesh through vaginal incisions. She said something that struck me as insightful. She said “If there is a significant risk of erosion of the mesh, or marrowing and discomfort in the vagina I would rather have the prolapse!”
Coincidentally I attended a discussion of mesh with the director of Urogynecology at UCLA. I had the privilege of training him as a resident and fellow. He reviewed the literature on vaginal mesh repairs and concluded that the patient must be openly consented for all the possible complications we are now aware of. He agreed that it takes at least 3 years on the market for new materials to be properly evaluated for long term safety. We are now at the 3 plus year mark and we are learning that the placement of vaginal mesh has some complications. I have decided that I will not use these mesh kits for repairs the first time, that I may only use them if a previous repair has failed requiring re-operation. This is just a small sub-group of patients.
In my experience I have seen several women who had this mesh placed elsewhere and then had complications. They were uncomfortable and in many cases I had to remove part or most of the mesh. It is quite difficult to remove all the mesh because it grows into the surrounding tissue. These women were uncomfortable with either pelvic pain, discharge and bleeding or all of these symptoms. Each of them said if they had understood the risks they would not have proceeded with the mesh. For the first (or a primary) repair it is usually advisable to use the native tissue and perform the least invasive surgery possible. In my hands that is a transvaginal hysteropexy or colpopexy ( uterine or vaginal suspension through the vagina) or a laparoscopic vaginal suspension if the woman has already had a hysterectomy. These procedures have good success, in the 80% range, and if there is a recurrence, it rarely requires another surgery, and if it does, we may have more information about mesh repairs by then.
At this time I will reserve my judgement and stick to native tissue repairs in most circumstances especially since the FDA (Federal Drug Administration) which regulates medical and surgical devices issued a warning about vaginal mesh last November 2008 pointing out that there are more mesh related complications than originally expected. Most of these are mesh exposures in the vagina and pain with intercourse. The erosion rate was in the 10 – 13% range. I agree with the above patient, I would rather have prolapse, or try a procedure without those particular risks, even if it had slightly more recurrences.
Your article is very informing. I have been contemplating whether to use mesh or not to use mesh for prolapse surgery. Have been reading articles as to the pros and cons and it is very scarey. I am beginning to agree with the woman mentioned in this article.
I also need to have my uterus removed at the same time as there is thickening in the lining that seems to get worse as time goes on and I have cancer in my family. Was wondering, what effects if any, this may have on the surgery. Thanks for any comment you may have on this situation as well.
Concerned