The Truth About Mesh in Female Pelvic Medicine and Reconstructive Surgery

Amos Adelowo, MDPolypropylene mesh material has been used in most surgical subspecialties and in millions of patients for over five decades. In my field of Female Pelvic Medicine and Reconstructive Surgery, the use of permanent mesh material is often used for the treatment of pelvic organ prolapse, which is when the pelvic organs drop due to weakened pelvic muscles, and stress urinary incontinence, which is the involuntary leakage of urine after physical activity, such as sneezing, coughing, and laughing.

In July 2011, the U.S. Food and Drug Administration (FDA) released an advisory on the safety and effectiveness of surgical mesh in the treatment of pelvic organ prolapse. In addition, there has been significant media attention surrounding this issue, and lawyers have targeted women who have had mesh placed, promising big payouts for their pain and discomfort.

Because of these developments, many women are confused, fearful, and may not seek treatment for bothersome pelvic floor conditions that significantly impact their quality of life. As a care provider in the Division of Female Pelvic Medicine and Reconstructive Surgery at Emory, my goal is to provide patients with the best information and care for their conditions. Here are some things you should know about mesh and pelvic floor disorders before making any health decisions.

Not All Mesh is the Same

Mesh is used in the mid-urethral sling surgery commonly used for the treatment of stress urinary incontinence for women who leak urine after coughing, sneezing, laughing, running, etc. This surgery is the leading treatment option and current gold standard for stress incontinence surgeries. The FDA has clearly stated that the polypropylene mid-urethral sling is safe, effective and it is not the subject of the 2011 FDA safety communication on the use of vaginally placed mesh for pelvic organ prolapse surgery.

The way we place the mesh is also a factor. Abdominally placed mesh with the option of a minimally invasive approach to placement has been used over many years with excellent results. The FDA’s communication focused on transvaginal placement of mesh products for treatment of pelvic organ prolapse.

Transvaginal Mesh is Not the Only Option

Some women don’t seek help for pelvic floor disorders because they are worried about transvaginal mesh, but we have many other options for treating prolapse and incontinence. These include non-surgical options, including physical therapy or a support device known as a pessary, as well as other surgical options that do not include the use of transvaginal mesh. We also offer minimally invasive surgical options that result in quicker post operative recovery, less blood loss and shorter hospital admission after surgery.

Transvaginal Mesh is Still a Good Option for Some Patients

Some of our surgical options use materials that aren’t permanent, so the results may not last as long as repairs made using permanent mesh. Studies show that using mesh can significantly lower the failure rate of these surgeries. Based on the current available information, many patients undergoing pelvic organ prolapse surgery with the use of mesh augmentation will heal well and have no problems. They will experience relief from their symptoms and improvement in function of the lower urinary tract.

Removing Transvaginal Mesh

In our practice, we care for women referred to us from other institutions with mesh complications. We occasionally have to “revise” a surgical mesh by either releasing the tension or excising a small exposed area. We do have the experience and training to remove mesh, as we have done so in patients with complications from their mesh surgery.

Our Team Understands and Can Manage the Risks

The risks associated with transvaginal mesh surgeries as well as other prolapse surgeries include pain, infection, urinary problems, bleeding, and painful sexual intercourse. Many of these complications can be treated and resolved in most patients, with management ranging from an in-office visit to another surgery. There is a small but significant group of patients who experience permanent complications from the use of transvaginally placed mesh.

For this reason, our team at Emory provides extensive counseling on the choice of surgical approach and the materials that will be used. We also work to ensure that patients understand what signs and symptoms should concern them after surgery. We provide an open line of communication and access for our patients to be seen and evaluated in a timely fashion if they are concerned.

We also believe in the importance of a multidisciplinary care team for all of our patients with pelvic floor dysfunction, including those with mesh. At Emory, our team includes urogynecologists, urologists, colorectal surgeons, radiologists, gastroenterologists, and pelvic floor physical therapists. We believe this approach provides optimal care with best outcome, and it gives our patients the benefit of receiving input from different subspecialists without multiple client visits.

Conclusion

It’s important to know that the symptoms associated with pelvic floor disorders – urinary incontinence, fecal incontinence, prolapse, and sexual dysfunction – are not a normal part of aging and are treatable. We will work with patients to find a treatment option that improves their quality of life. If concerns about transvaginal mesh are holding you back from seeking treatment, please reconsider and talk to your health care provider.

About Dr. Adelowo

Amos Adelowo, MD, MPH, FACOG, is an Assistant Professor in the Department of Gynecology and Obstetrics at Emory University School of Medicine. He is a member of the Female Pelvic Medicine and Reconstructive Surgery division, also known as urogynecology. Dr. Adelowo sees patients at the Emory Clinic at Emory University Hospital Midtown, on the 8th floor. He completed medical school at Pennsylvania State College of Medicine and his residency in obstetrics and gynecology at the University of Massachusetts Memorial Hospital. He then completed his fellowship in Female Pelvic Medicine and Reconstructive Surgery at Mount Auburn Hospital and Harvard Medical School. To make an appointment with Dr. Adelowo or any of our urogynecologists, please call 404-778-3401.

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  • Melba

    ALL MESH is bad and it is killing women and maiming them for life. I am one of the ones that has been maimed. You do not understand the complications until you have been implanted with mesh. It would only take you or one of your loved ones to have the horrific experience that a mesh injured person has had to come to terms with the fact that you are killing people to earn a buck! SICKENING!

  • Noreen Trenholm Wideman

    All the counseling in the world is not worth a penny regarding polypropylene mesh suburethral slings if doctors have no tests to distinguish who and who will not be high responders to polypropylene meshes. It also bothers me that the good doctor believes the fear about mesh was generated by lawyers. Apparently he does not realize the thousands of women who look for support from other mesh affected women talk to each other and share their experiences with mesh injury. When many women have been told the pain was in their heads they turned to other mesh injured women who were not afraid to speak up and say mesh hurts! Many of us would forfeit any compensation for mesh injury if the manufacturers recalled their polypropylene mesh products. Polypropylene mesh is not an ideal implant material. As long as there is no reason such as lawsuits for mesh injury to change the perception of mesh safety we feel doctors who do not suffer the complications of mesh are content to continue to indiscriminately use these products and let a significant subgroup of women be collateral damage. Make polypropylene mesh products for implanting face FDA level three approval process if doctors think it is so safe.