Is Vaginal Mesh for Prolapse Repairs Safe?

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Ambulance chasing lawyers have found a new victims’ rights to champion. Not so fast…

The organs in your pelvic cavity—uterus, vagina, bladder and rectum—are held in place by a web of muscles and ligaments that act like a hammock. When these tissues become weakened or damaged (typically during childbirth, and/or after hysterectomy), one or more of the pelvic organs fall (prolapse) into the vagina. As a result, the organs may press against the vaginal wall and produce a hernia-like bulge causing discomfort, limiting sexual and physical activity, or impair bladder or bowel function.

Pelvic organ prolapse (POP) currently affects 1 in 11 women and Stress Urinary Incontinence (SUI) — urine leakage with coughing, exercise etc. — 1 in 6. Just as prolene mesh has replaced plication groin hernia repairs so has it revolutionized the urethral sling for SUI over 15 years ago and is similarly changing POP repairs.

While urethral mesh slings have rare complications and have become the gold standard, using larger pieces of mesh for POP corrective surgery has been controversial with setbacks. The good news is significant evolution has occurred over the past decade with lighter weight prolene mesh that has lowered the risk of exposure to less than 10% (which does require an outpatient, small revision of the mesh that fortunately doesn’t affect restored support). Contrast this with a 30 40% failure rate of non grafted cystocele (bladder prolapse) repairs, where these women require complete reoperation in a scarred field ripe for complications. After all these women have poor pelvic ligaments that tore during childbirth creating these vaginal hernias.  Hence, improved success (better than 90%) and longevity of a mesh-augmented repair for women with moderate to severe prolapse becomes a compelling choice.

We have been approached by numerous concerned patients who have been misled by these alarming ads that the FDA recalled mesh products. This is not true.  The FDA now requires surgeons to communicate about the risks to their patients contemplating POP surgery—with and without mesh augmentation; We have been doing so since we began using grafts years ago. The FDA has a list of 13 questions that patients should ask their doctor including their experience performing these complex procedures. It’s only fair that women suffering with prolpase recieve balanced information so they can make an educated decision about surgery, or alternatives such as a pessary. It’s unfair to have medicine dictated by greedy lawyers influencing these women into tolerating prolapse and its impact on bowel, bladder, and sexual function.