Urologic Conditions & Treatments

Use of Vaginal Mesh Chattanooga TN

What are the uses of synthetic vaginal mesh?

vaginal mesh tnPelvic organ prolapse (POP) is a condition in which the pelvic organs such as the bladder, intestines, rectum or uterus push (prolapse) against the wall of the vagina and may be felt as a bulge within or coming out of the vagina. Stress Urinary Incontinence (SUI) is the leakage of urine associated with coughing, sneezing, exercising and other exertional activities. Both conditions may be associated with weakness of the muscles and tissue of the pelvis.

Synthetic vaginal mesh has been used to surgically treat both conditions and may provide benefits to certain patients over techniques that do not utilize vaginal mesh.

Is the mesh used to treat pelvic prolapse the same as that used to treat stress incontinence?

While similar materials are used in both types of mesh devices, it is important to understand that there are critical differences between the use of mesh to treat Pelvic Organ Prolapse (POP) and Stress Urinary Incontinence (SUI). These differences are often misunderstood by patients and this misunderstanding may be reinforced by what patients see in the media.

What are the complications of mesh used to treat pelvic organ prolapse?

Mesh procedures to treat POP may result in mesh passing through the bladder or urethra (perforation), mesh exposed through the vaginal wall, pain with sexual intercourse, pelvic pain or other complications. Some of these complications are associated with any POP repair, while some of these complications are unique to vaginal mesh. The FDA recommends that providers treating patients with vaginal mesh should have rigorous training in pelvic surgery, including proper training in mesh implantation techniques and management of complications that may arise. Patients should also be fully informed of the risks associated with all pelvic surgeries, including those unique to vaginal mesh.

How are mesh slings treating stress urinary incontinence different from mesh treating pelvic organ prolapse?

Patients should understand that there are fundamental differences between procedures that use mesh to treat Pelvic Organ Prolapse (POP) and Stress Urinary Incontinence (SUI). Mesh slings to treat SUI have been extensively studied over the last 2 decades and result in minimal patient harm when compared to alternative treatments for SUI. While there are complications that are unique to mesh slings, they are often easier to correct than complications from mesh POP repairs. The American Urological Association has released guidance indicating that mesh slings for treatment of SUI are appropriate treatment and are just as effective as non-mesh treatments with less recovery time and faster return to normal urination. Most surgical procedures for SUI today are mesh slings.

Did the FDA remove vaginal mesh from the market?

In July 2011, the FDA released a safety communication regarding the use of vaginal mesh specifically for the treatment of Pelvic Organ Prolapse (POP), stating that complications with vaginal mesh are not rare. Currently the FDA has proposed reclassifying the category of controls used to approve vaginal mesh for POP. Vaginal mesh for POP continues to be used under prior FDA approval and its use is still approved by the FDA.

The safety communications and reclassification do not apply to mesh used in treating SUI. Unfortunately, media attention and advertisements for legal action may have given some patients the impression that the FDA advisory applies to both types of procedures. The general medical opinion of mesh slings to treat SUI is positive and the FDA has said “The safety and effectiveness of multi-incision slings is well-established in clinical trials that followed patients for up to one-year.”

Most experts agree with the FDA’s opinion that those who implant vaginal mesh should have rigorous training in pelvic anatomy, have experience in mesh implantation and managing its complications, and provide patients with all information regarding mesh procedures including alternatives. Most experts also believe that in a certain group of women, mesh pelvic prolapse procedures are an important option that may provide benefits that justify the risks that are unique to mesh prolapse repairs.

Are synthetic slings safe and effective in treating stress urinary incontinence?

Stress urinary incontinence is a very common condition affecting millions of women, some profoundly. While more conservative therapies such as pelvic floor exercises (sometimes called Kegel exercises) should be tried first, some women will still need surgical therapy to improve their urinary leakage and resume a more normal life.

An FDA safety communication in July 2011 addressed concerns arising from the use of mesh to treat Pelvic Organ Prolapse (POP). This communication did not apply to mesh slings used to treat Stress Urinary Incontinence (SUI). However, subsequent media reports and some advertisements for legal actions may have given many patients the wrong impression about these slings.

There are over 2000 studies that have focused on mesh slings for treating SUI, making them the most extensively studied therapy for SUI. Included in these studies are the most rigorous and reliable type of study (called randomized controlled trials). Mesh slings to treat SUI are at least as effective as available alternatives and result in shorter recovery and faster return to normal voiding.

Most experts conclude that the mesh sling represents the standard of care for treatment of SUI, an opinion held by the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction. The most recent guidance from the FDA states that the type of sling most commonly used to treat SUI is both safe and effective.

If I had vaginal mesh placed to treat pelvic organ prolapse, what should I do now?

The use of vaginal mesh to treat pelvic organ prolapse, as with any pelvic surgery, is associated with risks. Some of the risks associated with vaginal mesh are unique to these products. The use of vaginal mesh to treat pelvic organ prolapse is appropriate for certain groups of women and should be performed by surgeons with proper training and experience with implanting vaginal mesh. Patients should be aware of the risks associated with the procedure as well as the alternatives to mesh prolapse repair.

Most women who undergo mesh prolapse repair have no complications and are satisfied with the results of the procedure. There is no reason why women who have satisfactory results and have no symptoms attributable to vaginal mesh should attempt to have their mesh modified or removed.

Women who experience a complication that may be associated with vaginal mesh such as pelvic pain, pain with intercourse, exposure of mesh through the vaginal wall or passage of the mesh through the bladder or urethra (perforation), should seek the care of a physician experienced in the evaluation and management of mesh complications.

What is my next step?

The use of vaginal mesh, either for the treatment of Pelvic Organ Prolapse (POP) or Stress Urinary Incontinence (SUI) should be a carefully considered decision made after discussion with a surgeon who can provide you with all of the information you need. At UT Urology, our staff incudes urologists who have complete fellowship training that includes a focus on both incontinence and pelvic reconstruction. This specialized training, along with years of experience with all types of vaginal mesh, means that you will have access to multiple options for your treatment,

For patients who may be experiencing a complication from a previous mesh surgery for either POP or SUI, our training and experience allow us to care for even the most complicated patients. Call today for your evaluation at UT Urology.

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