We feel that more data is needed to support the use of synthetic vaginal mesh for posterior vaginal wall and apical prolapse
Pelvic organ prolapse occurs when the pelvic tissues are weakened, similar to a hernia in other parts of the abdomen. To correct prolapse, some physicians in the late 1990s began adopting approaches commonly used to fix hernias, using large sheets of synthetic mesh to hold the prolapsed organ in place.
Although it made sense at the time to try the same technique for prolapse in the vagina that general surgeons were using to fix hernias, the ramifications were unfortunately not known until much later. It was found that the stiffer mesh and softer vagina tissues can rub together and lead to erosions in some patients.
In general, potential complications related to graft and mesh include erosion, infection, pain during intercourse (dyspareunia), fistulas, and chronic pain. Rates of these complications vary greatly and have not always been consistently reported.
Three to 12 months after vaginal prolapse repair with synthetic mesh, erosion of mesh varies widely from 3 percent to 17 percent – meaning placing transvaginal mesh carries greater risk than placing biologic grafts.
Earlier generations of mesh that were woven from multiple threads also had a higher rate of erosion and complication than the currently used wide pore monofilament mesh.
While some experienced surgeons have reported erosion rates as low as 2-3 percent, the largest series describing short-term complications in 289 women notes an erosion rate of 10 percent.
Other complications such as fistula, new onset (de novo) painful intercourse (dyspareunia), and chronic pain are not routinely reported, and are described mostly in case reports and small series. However, at University of Colorado Urogynecology, we are increasingly seeing these complications in our referral practice.
In 2008 and again in 2011, the Food and Drug Administration (FDA) issued a public health notification making recommendations regarding the serious complications associated with transvaginal placement of surgical mesh for the repair of pelvic organ prolapse and stress urinary incontinence.
This FDA report described receiving 1,000 reports of complications over three years. The most frequent complications noted in the health notification included erosion through vaginal epithelium (the thin top layer of vaginal tissue), infection, pain, urinary problems, and recurrence of prolapse and/or incontinence.
The report also noted that complications included vaginal scarring and mesh erosion, which in some cases led to a significant decrease in patients’ quality of life due to discomfort and pain, including painful intercourse (dyspareunia).
Although the current evidence does support the use of synthetic mesh to augment repairs of anterior vaginal prolapse, this is done at the expense of an increased rate of complications – particularly mesh exposure. Unknown durability and lack of long-term data are the unique risks of mesh and should be discussed with your doctor.
At this time, no one at University of Colorado Urogynecology places transvaginal mesh. We feel that more data is needed to support the use of synthetic vaginal mesh for posterior vaginal wall and apical prolapse.
All patients considering transvaginal mesh should be offered a copy of the FDA public health notification before providing consent. In addition, the patient should be provided a written copy of the labeling from the surgical mesh manufacturer, if available.
University of Colorado Urogynecology is a specialty women’s health practice focused on female pelvic health and surgery. Our physicians are also professors & researchers for the CU School of Medicine, one of the top-ranked medical schools in the nation.