A doctor discusses transvaginal mesh

What is Transvaginal Mesh?

Transvaginal mesh is a surgical implant designed to help women with pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Generally, it is used as a last resort after other methods have failed to produce the desired result. The mesh itself is based on a design used to treat hernias and is essentially a small sling made of polypropylene (a type of plastic), other synthetic materials, or even animal tissue.

While the implant can be placed via the abdomen, it is more easily inserted into and through the vagina, thus the term “transvaginal.” Eventually, the mesh is intended to meld with the surrounding tissue, hypothetically providing a permanent solution to the problem.

Transvaginal Mesh Uses

Pelvic organ prolapse occurs when organs such as the bladder begin to prolapse (or fall) onto the vaginal wall.  Stress urinary incontinence is a condition where urine inadvertently leaks from the bladder due to stress from physical activity. This differs from regular urinary incontinence, where the muscles in the bladder contract and release urine, even in a resting state. These issues are similar to a hernia, and they generally occur after large amount of strain is placed on the vaginal area, like during childbirth, a hysterectomy, or menopause. When the vaginal walls and pelvic muscles have been so overused they begin to weaken and can no longer provide the necessary support to keep everything in its proper place.

For women with POP, transvaginal mesh keeps the prolapsed organs from continually pushing and falling onto the vaginal wall. It lifts them back up and holds them in place,  and provides additional support. When the presenting problem is SUI, the support is more directed toward relieving stress on the bladder and preventing incontinence. 

Side Effects

While there has been success with transvaginal mesh implants, not all products are created equal. In some cases, very serious side effects may occur—not only can the original problem get worse, but new issues may arise. Using the mesh to repair SUI is generally less dangerous than when it's used to treat POP, but both come with their own set of potential problems. Among a whole host of other issues, the most frequent side effects are erosion and organ perforation.

The FDA states erosion as the most common side effect of the transvaginal mesh implant. Although the mesh is supposed to merge with the vaginal tissue, sometimes it can actually wear through this tissue instead. It may become externally visible and cause considerable pain to the vaginal area, especially during sexual intercourse. The urinary tract is also susceptible to erosion, which may result in frequent urinary tract infections (UTIs).

Organ perforation is a potentially more dangerous side effect. Rather than tearing through the vaginal wall or urinary tract, the mesh can actually perforate nearby organs. This is exceptionally alarming, considering those organs include the bladder and bowels. If punctured, they may release waste into the bloodstream and cause septic shock. Other potential repercussions of organ perforation include the need for further surgeries to remove the mesh and repair damaged organs.

Alternatives

Thankfully, transvaginal mesh is not a woman’s only option. In some cases, these issues can be fixed through methods as simple as a change in diet, weight loss, or specific workouts (like kegel exercises). Additionally, the Mayo Clinic has developed an alternative surgical treatment known as an “autologous transobturator midurethral sling procedure.” In this method, the woman’s own tissue is used to create the sling, instead of implanting the foreign-body plastic mesh.

While some doctors still use the transvaginal mesh technique quite frequently, many have fallen away from it. The side effects often outweigh the potential benefits and result in costly continued surgery. Additionally, lawsuits from many of these products are rampant.

If you or someone you love is experiencing pelvic organ prolapse or stress urinary incontinence and a doctor has recommended a transvaginal mesh, be sure to ask questions about the type of mesh used and typical results. Most importantly, do plenty of research based on your particular situation.

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