What is Surgical Mesh?
Surgical mesh is a fabric netting that is made from animal tissue or synthetic material. Mesh has been used for a long time in surgery and it is safe. There are different types of mesh used for surgery:
- Biological graft mesh—made from the disinfected intestines or the skins of pigs and cows. This type of mesh is absorbable. It, thus dissolves into the body over several months.
- Synthetic dissolvable mesh—made from a soft, suture material woven into fabric. It is also absorbable and goes away after several months.
- Synthetic permanent mesh—made from medical grade plastic fabric, often polypropylene. This type of mesh is not absorbed by the body. It is designed for long-term use.
Concerns about mesh side effects do not include surgeries done with biological graft or synthetic dissolvable mesh. The problems relate to the use of synthetic permanent mesh for one specific type of pelvic organ prolapse (POP) mesh surgery. Read on to learn more.
How is Mesh Used to Treat Pelvic Floor Disorders?
Pelvic floor disorders (PFDs) are a group of conditions that affect the pelvic floor. The pelvic floor is the set of muscles and other tissues in the lowest part of the pelvis that support the organs such as the bladder, vagina and rectum. If those muscles and tissues weaken or get damaged, the organs may drop out of the body. When this happens, some women may also leak urine.
Mesh is used to provide short-term or long-term support for weak and damaged body tissues, such as those in the pelvic floor. It helps to reinforce your body tissues. Thus, the type of mesh used depends on your diagnosis and the reason for the surgery:
- Short-term support of tissues—biological graft mesh and synthetic dissolvable mesh are used.
- Long-term support—synthetic permanent mesh provides is used.
Plus, depending upon on your individual situation, the surgeon will determine where and how to place the mesh. And, if permanent or dissolvable mesh is needed.
What PFD Surgeries Require Mesh?
Surgeons use mesh to treat two types of PFDs—stress urinary incontinence (SUI) and pelvic organ prolapse (POP):
- SUI is the leakage of urine with activities, such as laughing, coughing, sneezing, and straining. Mesh is used to help support the bladder or urethra, which is the tube that carries urine out of the body. SUI surgery is typically very successful and often low risk.
- POP is the dropping of the pelvic organs, such as the bladder, intestine, and uterus, caused by loss of normal support of the vagina. During POP surgery, the doctor inserts mesh to reinforce the weak vaginal wall. POP surgery can be done through the:
- Abdomen, called transabdominal
- Vagina, called transvaginal
Thus, for both these conditions, the mesh is placed in the pelvic area to reinforce weakened body tissues. Most women who have these surgeries are happy with the outcomes.
Safety concerns: Many women who had mesh surgery have done well. But, mesh surgeries like all surgeries have risks. And, the risks for the mesh used to treat SUI are not the same as the risk for mesh used for POP repair. Also, there are different risks related to because of where and how the mesh is placed. Plus, the risks vary depending on whether it is permanent or dissolvable mesh.
The recent concerns about mesh risks are linked to transvaginal POP surgery only. We now know that the risk of complications for transvaginal repair can be high. After this particular surgery, many women report serious complications. For example, infection, pain, urinary problems, vaginal scarring, and urinary incontinence. Plus, in some women, the mesh dislodged and moved into the surrounding tissue—this mesh may erode into those tissues and damage organs. Because of this, the Food and Drug Administration is requiring mesh makers to conduct further tests. These companies must provide stronger proof on the safety and effectiveness of this type of mesh device.
Talk with your doctor about risks before the surgery. And, make sure you understand clearly any mesh surgery your doctor discusses. Ask questions, take notes and consider bringing along a friend or family member to listen as well.
What Should I Ask My Doctor Before Mesh Surgery?
Before you have mesh surgery, talk with your doctor about the following five things:
- First, find out if you are a good candidate for mesh surgery. Women who smoke or have poorly controlled diabetes are at a higher risk for complications. Thus, they may not be good candidates for a mesh surgery.
- Also ask about the specific surgery. Complications for SUI mesh surgery and POP transabdominal are low. Risks are higher for POP transvaginal surgeries.
- Talk with your doctor about the benefits. Request a list of all potential risks and complications.
- Discuss quality of life issues with your doctor.
- Find out about other treatment options. Assess the risk and benefits of the surgery based on those quality of life factors.
Also, seek a second opinion and ask to go over the same information with that surgeon.
Should I Get the Mesh Removed?
Most women who have mesh surgery recover well and find relief of their symptoms. It is rare that a woman who has SUI mesh surgery or POP transabdominal surgery needs to have the mesh removed. Women who had transvaginal POP surgery, however, may need to consider mesh removal surgery.
Transvaginal POP surgery uses a permanent mesh material. Over time, body tissues grow into the holes of the mesh to help hold it in place. If the mesh has moved out of place, it may be embedded in other body tissues and pelvic organs. If the side effects of the mesh device are so severe that they outweigh the benefits, the doctor may ask you about mesh removal surgery.
Surgery to remove transvaginal mesh is very complex. Mesh removal surgery requires a highly trained surgeon with special knowledge of the pelvic anatomy and POP surgery. During the surgery, the doctor attempts to remove as much of the mesh as possible. Plus, damaged tissue is repaired. For many women, more than one surgery is required to fully repair the pelvic area.
If you have serious complications related to the mesh, talk with your surgeon about the need to have the mesh devise removed. The discussion will require you to weigh the impact of the side effects on your quality of life with the risks associated with the removal surgery. It is a hard decision. Take time, to review the risks and benefits with your surgeon.
Learn More About the Benefits and Risks of Mesh Surgeries
Download the fact sheet about the surgery your doctor recommends. Take it with you to your appointment to help review the risks. Ask the doctor about the benefits and risks that might apply to you based on your individual diagnosis and health status.
Read More About Surgical Mesh