Concerned about transvaginal mesh complications associated with treatments for pelvic floor disorders? Here's what you need to know.By Mayo Clinic Staff
If you're a woman who has a pelvic floor disorder, you've likely heard of treatments involving transvaginal mesh. However, reports about complications might have you confused or hesitant to seek treatment. Understand the concerns about transvaginal mesh and what they might mean for you.
Surgical mesh is a medical device that is used to provide extra support when repairing weakened or damaged tissue. Most surgical mesh devices are made from synthetic materials or animal tissue.
Surgical mesh can be used to treat:
- Pelvic organ prolapse (POP). When the muscles and ligaments supporting a woman's pelvic organs weaken, the pelvic organs can slip out of place (prolapse). To treat POP, surgical mesh can be implanted to reinforce the weakened vaginal wall. Surgery can be done through the abdomen (transabdominal) or through the vagina (transvaginal).
- Stress urinary incontinence (SUI). This is the unintentional loss of urine due to a physical movement or activity — such as coughing, sneezing, running or heavy lifting — that puts pressure (stress) on your bladder. Surgical mesh can be implanted through the vagina to support the urethra or bladder neck. This is known as a midurethral sling or a mesh sling procedure.
Each type of mesh procedure carries its own risks and benefits.
Due to reports of complications during or after surgery for POP, in 2016 the FDA changed the classification of surgical mesh to repair POP transvaginally from a moderate-risk device to a high-risk device. The FDA orders apply only to transvaginal use of surgical mesh to treat POP. The orders don't apply to the use of transvaginal mesh for SUI.
Research has shown that surgical mesh for transvaginal repair of POP can cause complications such as mesh erosion, pain, infection, bleeding, pain during sex, organ perforation and urinary problems. Many of these complications require additional treatment, including surgery.
Treating SUI with a mesh sling also can cause complications, including mesh erosion, infection and pain. However, some research suggests that the complications are less frequent and usually less severe than are complications associated with surgical mesh for transvaginal repair of POP, and usually do not require follow-up surgery.
If you're considering treatment for a pelvic floor disorder that involves surgical mesh, be sure to have your health care provider explain all of your options, as well as their possible risks and benefits. In particular, be aware of the risks associated with surgical mesh for transvaginal repair of POP, such as the need for additional surgery due to mesh-related complications.
July 22, 2017
- Maher C, et al. Transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse. Cochrane Database of Systematic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD012079/full. Accessed May 22, 2017.
- Trabuco EC, et al. Overview of transvaginal placement of mesh for prolapse and stress urinary incontinence. http://www.uptodate.com/home. Accessed May 22, 2017.
- Obstetrical and gynecological devices: Reclassification of surgical mesh for transvaginal pelvic organ prolapse repair. Office of the Federal Register. https://www.federalregister.gov/documents/2016/01/05/2015-33165/obstetrical-and-gynecological-devices-reclassification-of-surgical-mesh-for-transvaginal-pelvic. Accessed May 22, 2017.
- Caveney M, et al. Short-term complications associated with the use of transvaginal mesh in pelvic floor reconstructive surgery: Results from a multi-institutional prospectively maintained dataset. Neurourology and Urodynamics. 2017;9999:1.
- ACOG practice advisory on the FDA's reclassification of mesh for pelvic organ prolapse. The American College of Obstetricians and Gynecologists. http://www.acog.org/About-ACOG/News-Room/Practice-Advisories/ACOG-Practice-Advisory-on-the-FDAs-Reclassification-of-Mesh-for-Pelvic-Organ-Prolapse. Accessed May 22, 2017.
- Surgery for stress urinary incontinence. The American College of Obstetricians and Gynecologists. http://www.acog.org/Patients/FAQs/Surgery-for-Stress-Urinary-Incontinence. Accessed May 22, 2017.