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Incontinence

19 November 2018

What you should know about the reversal of transvaginal mesh surgery

Mesh implants to treat urinary incontinence can cause serious side effects. Therefore, many patients are looking to have theirs removed. Here’s what you should know about the procedure.

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Transvaginal mesh is often offered as a solution for women who suffer from urinary incontinence. This procedure entails the implanting of mesh made from synthetic propylene to fix pelvic floor prolapse and stress urinary incontinence.

Although the procedure sounds non-invasive and simple on paper, the statistics tell an entirely different story. During the past couple of years, the transvaginal mesh procedure has come under the spotlight – and several lawsuits have been filed.

Common complaints were that it caused severe pain and discomfort, didn’t stop urinary incontinence despite being a costly procedure, and that it causes damage to the nerves around the bladder and the urethra.

Severe side effects

Other frequently reported side effects include infection, bleeding, pain during intercourse and the exposure of the mesh through the vagina. Vaginal scarring was also reported by the FDA.

Because of the severity of these side effects, many patients who underwent transvaginal mesh implants wish to reverse the surgery. Luckily, a procedure named transvaginal mesh excision makes this possible.

According to The Guardian, thousands of women who underwent the surgery have had their transvaginal mesh implants removed. According to the publication, this means that one in 15 women who opted for transvaginal mesh implants will eventually opt to reverse the procedure.

A recent study published online in Journal of the American Medical Association stated that at least 3.3% of mesh surgery will be reversed after at least nine years. The study examined 95 057 women who had mesh inserted to treat stress urinary incontinence. 

What does the procedure entail?

According to the UCLA School of Medicine, transvaginal mesh removal is a complicated, technical surgical procedure that requires a highly skilled surgeon.

In some cases, additional surgery may also be needed to correct the original prolapse or any other serious complications caused by the mesh.

What makes this procedure difficult?

Transvaginal mesh is considered a permanent implant and often results in tissue growing around the mesh, which means that it can only partially be removed. Removing the mesh without damaging the surrounding tissue and organs is difficult.

According to Dr Prenevin Gordin, a Cape Town-based urologist and Health24’s incontinence expert, the mesh is divided rather than entirely removed. He also says that the insertion of mesh, which is also called a “sling”, should be carefully considered and that your doctor should inform you of all the possible risks and side effects.

Is the removal safe?

A previous study cited on Health24 in 2014 mentioned that the removal of a transvaginal mesh implant might not necessarily improve side effects caused by the implant. According to study authors, it is not always clear whether the symptoms are definitely caused by the mesh implant and that removal of the implant will improve the situation.

That being said, the overall outcome of the study was positive – the study followed 123 women who underwent mesh removal surgery. Out of the 123 subjects, 67% experienced improvement in pain and side effects.

Another study published in 2017 in the Journal of Urology looked retrospectively at clinical cases of transvaginal mesh removal over a period of eight years. Albeit a small sample size, the results were better and the outcome was that the removal of vaginal mesh is safe and that it can eliminate symptoms.

How should you be treating your incontinence?

The first port of call would be to consult your doctor who might refer you to a urologist. Although you might feel embarrassed at first, you should know that incontinence can be successfully treated or managed, even without surgical intervention. 

Consult your doctor immediately in the following cases when:

  • Home treatments and lifestyle changes don't make a difference.
  • There is blood in your urine.
  • Your incontinence gets significantly worse in a short amount of time, especially after a surgical procedure or medication.
  • You experience any additional physical weakness, which can signify a stroke.

Image credit: iStock

 

Ask the Expert

Incontinence Expert

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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