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.
1. Not all mesh is the same.
Different types of mesh placed for different diagnoses have different outcomes. The differences and problems that can be seen after mesh surgery occur because of where and how it is placed, and whether it is permanent or dissolvable mesh. 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.
2. There is not enough evidence to justify taking mesh completely off the market.
Many women who had mesh surgery have done well. Plus, many people have benefitted from placement of mesh in surgery for other problems like abdominal wall hernias. The differences in the uses and outcomes related to synthetic mesh depend on what it is used for and where it is placed. For example, different risks and benefits exist for the mesh used to treat SUI compared with mesh used for POP repair. Even mesh placed through an abdominal incision has different risks than mesh placed through the vaginal opening.
3. The FDA recommends specialized training for surgeons who place mesh for POP or SUI.
The FDA advices that doctors who do POP and SUI mesh surgeries obtain specialized training for each of these procedures. In addition, the surgeon is expected be aware of the risks of surgical mesh and thoroughly discuss these risks with women prior to the surgery.
Ask your doctor about his/her experience using this specific mesh product and treating complications associated with mesh placement. You want a surgeon who has done at least 50 of these surgeries and who can manage any postoperative complications. You also want a doctor who attends national meetings to stay current on the most up-to-date research, maybe even performing research themselves. Some doctors have recently become board-certified in prolapse and incontinence surgery (called Female Pelvic Medicine and Reconstructive Surgery). Ask your doctor about these things.
4. Synthetic mesh mid-urethral slings are currently the best option for SUI surgery.
Mesh mid-urethral slings for SUI are well studied and have a low complication risk. Extensive research shows that these slings are safe and effective. Read SUI Slings FAQs.
5. Mesh may be appropriate for repair of POP in some cases.
AUGS does not support the routine use of transvaginal mesh for the repair of POP, but there may be particular circumstances when the placement of transvaginal mesh is beneficial and appropriate. For example, a woman who needs repeat prolase surgery after an original surgery failed to hold up her vaginal walls may benefit from mesh placement.
Surgery is individualized to a woman’s anatomy and postoperative goals. Placement of transvaginal mesh for POP should be used cautiously only by experienced surgeons with extensive training in pelvic surgery. Mesh placed abdominally for POP repair (during a sacrocolpopexy) may result in lower rates of mesh complications compared to transvaginal POP surgery with mesh.
Discuss with your doctor the risks, benefits, and possible adverse outcomes of all available treatment options for you personally. Ask about non-surgical treatment options, such as pessaries, abdominal and vaginal surgical repairs that use your own tissues, and abdominal and vaginal mesh repairs.
6. The FDA now requires additional research studies to further understand these surgeries and their risks.
AUGS supports these research trials. AUGS supports the FDA’s request for better data to help clarify the circumstances for and types of mesh devices that are safe and effective.
7. Some mesh products designed to fix POP or SUI have been taken off the market, but do not always need to be removed.
This does not mean they have been recalled or need to be removed from a patient who has had surgery before. Mesh implants do not “expire.” If you are feeling well without any complications, the mesh can safely stay inside you. Consult your surgeon if you have questions about prior surgery.
8. Additional studies are going on now to help understand how to make mesh safer, so these recommendations may change with time.
The FDA is requiring extensive clinical trials with long-term follow-up. Manufacturers are required to test their products in women before marketing or selling them. For example, clinical trials are looking at transvaginal mesh in women and evaluating safety of this device for women who may use it.
9. Talk with your doctor.
Talk with your doctor about your specific problems and treatment. Make sure that you are clear and satisfied with the answers you get. It is important to be informed about all treatment options for POP and SUI. Each option has pros and cons.
Topics to Discuss with Your Doctor BEFORE Surgery
10. Find a specialist through AUG’s online provider directory.
AUGS' Find a Provider Directory is a public service for women who wish to locate a urogynecologist in their area. This directory contains the names and addresses of AUGS members whose professional activity is devoted to the practice of urogynecology. This data base can be searched by name, state, or zip code.