Transvaginal mesh, or TVM, is a net-like implant that is most often used to treat both pelvic organ prolapse (POP) as well as stress urinary incontinence (SUI) in women. While it may sound like a helpful form of relief for POP and SUI, the product design and implantation techniques have contributed to serious complications for women all over the globe, such as mesh erosion and organ perforation.
Typically, this transvaginal mesh is made out of a plastic material called polypropylene. When we say “transvaginal’ it is in reference to the type of surgical technique that is used to implant the mesh — through the vagina.
Both pelvic organ prolapse and stress urinary incontinence are conditions that typically affect women after having a hysterectomy, menopause, or childbirth.
This procedure, using this product, was created to help women suffering from SUI and POP, but it has been proven since their emergence that most, if not all, are neither safe nor reliable. Reports of complications came too late for hundreds of thousands of women who already had mesh implanted.
To best understand why this product was necessary to begin with, we need to explore the original causes for mesh: SUI, POP and results of a hysterectomy.
Pelvic Organ Prolapse
This occurs when organs sag or fall into the vaginal canal because of weak pelvic muscles. Transvaginal mesh serves as a hammock beneath the organs to hold them up. Usually, the bladder, uterus, rectum, or bowel is involved in the prolapse; the bladder is the most common organ affected. Depending on the organs involved, surgeons may place the piece of mesh on the front, back or top wall of the vagina. The type of mesh used also varies in shape and size.
This type of surgery is usually performed transvaginally. In fact, three out of four surgeries to treat POP with mesh were done transvaginally in 2010.
Stress Urinary Incontinence
This occurs when the bladder leaks urine during moments of increased physical activity that increases pressure on the bladder. The mesh is used to support the urethra when pelvic muscles weaken. Surgical treatment of SUI with mesh (usually called a bladder sling or vaginal tape) is the most common type of surgery used to correct the condition, and 80 percent of SUI mesh surgeries in 2010 were done through the vagina. Doctors use transvaginal placement of bladder slings because it is considered less invasive and the incisions are smaller.
Hysterectomy
After a hysterectomy, some women suffer from vaginal vault prolapse, which occurs when the vagina collapses in upon itself because of the removal of the uterus. In this case, mesh was surgically implanted on the top of the vagina and sewn into connective tissues to hold the vagina in place.
It is certainly true that transvaginal mesh surgery is simpler and less invasive than more traditional treatments for POP and SUI; however, it also carries a much higher complication rate. In 2011, the FDA reported that it had received 4,000 reports of complications related to transvaginal mesh in the previous six years. Additionally, the agency previously reported in 2008 that complications from transvaginal mesh used for surgical treatment of POP were rate, but in 2011 this changed; the FDA updated its statement and warned patients and doctors that they are not rate.
The most severe of complications, like mesh erosion and organ perforation, require surgery to fix. This is typically called revision therapy. However, synthetic surgical mesh was designed to stay in the body indefinitely; removal of the mesh is extremely difficult. Doctors must remove the mesh in pieces, one surgery at a time, because blood vessels and tissues grow around it as time goes on.
Like Drs. Miklos and Moore, those who specialize in transvaginal mesh revision surgery are called urogynecologists. They receive special training in pelvic floor disorders like prolapse and incontinence, and are experienced in performing revision surgeries. It is truly unfortunate to be suffering from transvaginal mesh erosion or organ perforation as a result of a mesh procedure, and Drs. Miklos and Moore have done extensive research on the topic, and how best to go about finding relief for their patients. The doctors will do all that they can to get the mesh removed, and make you feel as comfortable as your former self.