Incontinence

Updated 26 July 2016

Transvaginal mesh dangers for stress incontinence

The use of synthetic mesh has increased in vaginal surgery since 2007, but with many recent lawsuits, what do we really know about the dangers of this procedure?

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Vaginal mesh is a synthetic plastic material called polypropylene. Transvaginal mesh refers to the process in which this plastic is implanted through the vagina. Although this procedure is becoming more common, it is also regarded as dangerous to some women.

Fixing pelvic organ prolapse

This surgical mesh is aimed at fixing pelvic organ prolapse (POP) and stress urinary incontinence (SUI) – conditions usually associated with childbirth, hysterectomy or menopause – permanently.

Pelvic prolapse occurs when the pelvic floor collapses causing a section of the vaginal canal to protrude through the opening of the vagina.

In this procedure, doctors can surgically insert the mesh vaginally or abdominally, but placing the mesh through the vagina is quicker and less invasive.      

Read: Incontinence procedure may lose effectiveness

The use of synthetic mesh has increased in vaginal surgery over the past few years due to more cases of women reportedly suffering from POP.

However, there are grave concerns about the safety and efficiency of transvaginally placed mesh.

Image: J&J mesh illustration and explanations published in the Wall Street Journal

MK CK774 MESH G 20140313181205

Permanent life-altering consequences

Based on the current limited data available, although many patients that undergo vaginal repairs heal without problems, there is seemingly a group of patients who experience permanent life-altering consequences.  

These consequences often include chronic pain and dyspareunia  from the use of vaginal mesh.

Pelvic pain, groin pain, and dyspareunia is common with pelvic reconstructive surgery whether the patient has a vaginal mesh implant or not.

However, a side effect that's unique to transvaginal mesh is erosion, which seems to be the most prevalent consequence and may sometimes present complications several years after the initial procedure.

Read: Removal of faulty mesh for incontinence may not improve women's symptoms

There are increasing claims of vaginal pain associated with changes that occur with mesh surgery and the product itself. One example of these is the 24, 000 lawsuits which manufacturer Johnson & Johnson is facing over its vaginal-mesh implants, recently reported in The Daily Record.

With all the negative publicity that transvaginal mesh surgery is getting, and the ever increasing demand for the restorative procedure it brings confusion.

Who are the best patients for transvaginally placed mesh?

Very little data exists as to who are the best patients for this procedure but it should be reserved for high-risk individuals in whom the benefit of mesh placement far outweighs the risks, such as individuals with recurrent prolapse.

Read: Common medicines tied to urinary incontinence

The approach to repairing POP should ultimately take the patient’s medical and surgical history, severity of prolapse, and preference after education regarding the benefits and risks of the (surgical and nonsurgical) alternatives into consideration.

Read More:

Caffeine linked to leaky bladder in men

Incontinence affects young women too

Most women don't need regular pelvic exams              

 

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Prenevin Govender completed his MBChB at the University of Cape Town in 2001. He obtained his Fellowship of the College of Urologists in 2009 and graduated with distinction for a Masters in Medicine from the University of Cape Town in 2010. His special interests include laparoscopic, pelvic organ prolapse and urinary incontinence surgery. He consults full-time at Life Kingsbury Hospital in Claremont.

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