Surgical insertion of vaginal mesh, potential complications, and associated risks
In the realm of women's health, a debate surrounds a medical intervention known as transvaginal mesh (TVM). This implant is used to strengthen weakened areas of the vagina, primarily for those suffering from pelvic organ prolapse (POP) or stress urinary incontinence (SUI).
However, the U.S. Food and Drug Administration (FDA) issued a press release in 2019, banning the continued manufacturing, selling, and distribution of TVM for POP treatment. This decision came in response to escalating reports of negative side effects associated with the procedure.
SUI, a condition where urine leaks out during physical movements like coughing, sneezing, or laughing, is another condition for which TVM may be used. In some cases, a mesh sling is placed to support the urethra.
Despite the ban for POP, mesh slings for SUI remain approved and in use under more stringent regulatory controls. Other countries, including the UK and Australia, have followed suit, restricting or banning TVM for POP due to safety concerns.
The concerns revolve around potential risks such as persistent vaginal bleeding, irregular vaginal discharge, recurrent urinary tract infections, pain or swelling in the pelvic area, discomfort during sex, infection of the bladder or bowel, incontinence, stabbing pain or a prickling sensation in the vagina, and pain in the abdomen, buttocks, or legs.
Pelvic floor therapy, involving exercises to strengthen the pelvic floor muscles, and alternative treatments like bladder training, absorbent products, medications, lifestyle changes, native tissue repair, biological graft repair, and bulking agents, are often considered before turning to TVM.
For those with a widened vaginal opening, narrow or shorter vagina due to surgery, vaginal scarring, vaginal dryness, weak pelvic floor muscles, or a narrow vagina, pessaries may not be suitable. Pessaries are silicone devices that can support organs that have dropped out of place or place pressure on the urethra to prevent urine leakage. Around 50-80% of females can successfully use a pessary, regardless of age, medical history, or the severity of their condition.
The American Urogynecologic Society (AUGS) supports the use of TVM in some situations, where it is the most appropriate treatment option. However, they emphasise the need for careful consideration and informed consent due to the potential risks.
Research is ongoing to develop safer surgical alternatives and mesh technologies. The medical community continues to grapple with the safety and efficacy of TVM, striving to improve patient outcomes and reduce complications.
For those who have experienced symptoms of complications from TVM, it is crucial to seek advice from a healthcare professional. It is also essential to note that, for those who have TVM implants but have no adverse symptoms, there is no need to remove the mesh unless there is a medical problem.
In conclusion, the use of transvaginal mesh for pelvic organ prolapse has been restricted due to safety concerns, while mesh slings for urinary incontinence continue to be used under stricter regulation. The medical community continues to explore safer alternatives, aiming to improve the quality of life for those affected.
- Although transvaginal mesh (TVM) for pelvic organ prolapse (POP) treatment has been banned, mesh slings for surgical procedures addressing stress urinary incontinence (SUI) remain approved and under stricter regulatory controls.
- Beyond TVM, pelvic floor therapy, bladder training, absorbent products, medications, lifestyle changes, native tissue repair, biological graft repair, and bulking agents are also considered for treating conditions like POP or SUI.
- Some countries, including the US, UK, and Australia, have restricted or banned TVM for POP due to medical-conditions related to its use, such as persistent vaginal bleeding, pain, and infection.
- Given the potential risks associated with breast-cancer and other female surgeries, it is imperative for women to seek advice from healthcare professionals about health-and-wellness concerns, including women's health issues like menopause and cervical cancer.
