Settling the controversy over transvaginal mesh procedures
What is transvaginal mesh?Transvaginal mesh (also called urogynaecological mesh or pelvic-floor mesh) is a medical device used to support weakened or damaged pelvic tissue. In the mid-1990s, tranvaginal synthetic mesh procedures were developed to treat stress urinary incontinence in women. Later, similar procedures were developed to treat pelvic organ prolapse.
How does the mesh work?
Treatment for stress urinary incontinencePatients undergoing a transvaginal mesh procedure to treat stress urinary incontinence (SUI) are fitted with a narrow strip of mesh under the urethra. The mesh acts as a sling to support the urethra or bladder neck. This is known as a midurethral sling or a mesh sling procedure. The sling helps to prevent loss of urine when pressure is exerted on the bladder, such as when an individual coughs, sneezes, exercises or lifts something heavy.
Treatment for pelvic organ prolapseTransvaginal mesh procedures may also be used to treat pelvic organ prolapse (POP). POP occurs when the muscles or ligaments holding a woman’s pelvic organs weaken to the point that the pelvic organs begin to slip out of place. In these cases, a square or trapezoidal sheet of mesh may be surgically implanted through the abdomen (transabdominal) or through the vagina (transvaginal) to recreate normal pelvic-floor support.
Why all the controversy?As with all surgical interventions, there are risks of complications with transvaginal mesh procedures. Most complications are minor; however, in a small number of cases the complications have been serious, including mesh erosion and exposure, pain, infection, bleeding, organ perforation, painful sex and urinary problems.
An extensive amount of research indicates that transvaginal mesh procedures are safe and effective for treating most women with SUI. In fact, studies show that mesh procedures are as-effective or more effective than traditional SUI operations, with low rates of short-term complications and similar rates of long-term complications.
The use of transvaginal mesh to treat POP is a different situation. Currently, research does not support the routine use of transvaginal mesh for prolapse repair. Although the procedure for POP is usually effective, there are higher risks of serious complications.
What should you expect?
Our functional reconstructive urologists are experts at treating pelvic floor disorders. If recommending a transvaginal mesh procedure, they will explain their rationale for recommending the procedure as well as alternative treatment options, benefits and risks.
Almost all women who undergo a transvaginal mesh procedure for SUI experience significant improvements in bladder control and quality of life.
For more information, check-out the Canadian Urological Association position statement on transvaginal mesh, which was co-authored by two of our urologists.