Vaginal Mesh Complications

Problems with Vaginal Mesh?

Vaginal mesh represent synthetic hammocks that are ideally supposed to fix urinary leakage. Mesh can also fix organs that are falling out, a condition called prolapse. Most surgeries go well. Unfortunately, a small percentage of vaginal mesh implantations can cause problems.

What are symptoms after transvaginal mesh implant surgery?

Surgery using mesh is done to fix pelvic prolapse (falling out bladder or vagina) or urinary leakage. We call these surgeries sacrocolpopexy, anterior repair, posterior repair, and urethral sling repairs. All these surgeries have variations and can use mesh. Normal symptoms after surgery usually go away by 6 weeks. This can include pain and some vaginal bleeding. Urination is usually normal right after surgery.

Sometimes, pain persists or starts to become a problem months after the procedure. Pain can occur during activity. Many times, the pain is during sex. Husbands or partners sometimes can feel the mesh and also complain of pain. These problems lead to social isolation and problems with intimacy. Women can gain weight because they no longer are active. Marriages undergo stress due to the lack of sexual intimacy.  In general, there are a couple of types of problems.

  1. Organ damage due to the mesh eroding into the bladder, urethra or other organs. Your doctor may state that your have a fistula or interstitial cystitis. A fistula is an abnormal communication between organs, such as the bladder and vagina. Getting interstitial cystitis after vaginal mesh may just be because of the mesh.
  2. Chronic symptoms. Mesh can injure nerves, causing pain. The mesh can shrink, which leads to pain and vaginal scarring.
    • New incontinence, sometimes without even coughing or straining.
    • Severe urgency
    • Pain during sex after mesh surgery
    • Partner having pain and actually feeling the mesh
    • Frequent urinary tract infections after mesh
    • Shortening of the vagina

Diagnosis?

Diagnosis of an erosion of mesh can be difficult. Sometimes the mesh has not eroded but it can cause severe symptoms as mentioned above. Physical exam in the office sometimes does not show the erosion. The folds in the vagina can hide areas of erosion. A look inside the bladder by an experienced urologist with a scope is sometimes necessary. This is why women who complain about symptoms to their doctor are sometimes not diagnosed properly. Women should find a doctor with a high level of suspicion. You should make sure the doctor knows that you had a prior surgery with mesh.

If you continue to have pain, urinary tract infections, new incontinence months after surgery, or blood in the urine, make sure you tell your physician or get a second opinion.

What is being done to fix the problem?

Removing vaginal mesh can be difficult. Mesh was not designed to come out. Many surgeons rightfully avoid mesh removal surgery due to potential risk of injury. Finding an experienced surgeon is important.

Physical therapy and medical therapy are also used to help address mesh-related issues. Medication such as estrogen can help rebuild the vaginal wall and treat minor cases of erosion. Physical therapy can help with abdominal or pelvic pain. However, for some, these treatments are not enough. These women could even undergo surgery to attempt removal of the mesh.

We can help remove the vaginal mesh. Dr Kella typically does not replace the mesh after the surgery.

Sometimes, the original problem leading to the mesh placement may return. Once the mesh problem is fixed and the tissue heals, any new problems can be assessed. Dr Kella may recommend laser therapy to help fix vaginal atrophy or mild incontinence. This could help revitalize vaginal tissue and avoid future surgery.

Vaginal mesh was hailed as an easier way to fix women’s leakage and prolapse. Industry aggressively courted surgeons to implant mesh. In 2010, nearly 300,000 transvaginal mesh surgeries were performed. Some of these surgeries led to poor results.

Women have requested removal of mesh due to erosion, chronic pain and sexual dysfunction.

We have developed a significant expertise with this procedure. At The Urology Place, Dr Kella typically removes mesh after conservative measures have failed. Pelvic floor therapy and estrogen are useful tools to try before surgery. With surgery, we remove mesh usually in the same way that it was placed. Abdominal surgery with mesh placement usually has higher risk of complications. Patients will typically stay overnight. The surgical robot can be used to deal with some of the mesh problems.

Vaginally placed mesh is usually easier to remove. Dr Kella is able to usually discharge patients home the same day. Pain is minimal. A catheter is placed in the bladder during surgery and is typically removed prior to going home. Women are able to walk and can feel an immediate improvement. Leakage could worsen but surprisingly is stable in many women. After a few weeks without the mesh, if leakage is worse, non-mesh options can be discussed to fix the problem.

Residual pain, vaginal dryness, and mild incontinence could be addressed with vaginal laser treatment. This therapy could be very helpful for recovery of function.

Contact our office for a consultation and to learn about your options. Call us at 210-617-3670.  Or fill out our form to the right and we will reach you within 2 business days. We are based in San Antonio, Texas. If you are coming from a further distance, we can set up a time to discuss your problem. Spanish speakers are welcome to call or fill out the form as well.

To learn more, here is a good link for mesh complications.

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VAGINAL MESH REMOVAL: QUESTIONS AND ANSWERS

Questions and Answers Regarding Vaginal Mesh Revision Surgery

Dr Kella became interested in mesh removals when a patient asked if he could robotically remove a mesh erosion. The case was similar to fistula cases. A fistula is a situation where an abnormal connection between organs exist. For example, a connection between the bladder and vagina. Some cases can be done through a vaginal approach. These cases can be difficult and patients have come from around the United States to have their mesh removed by Dr Kella.

Many women do fine from their surgery. The problem is that manufacturers pushed mesh as a solution for all doctors to solve all problems for all women. Once manufacturers realized that this was a problem, not enough was done to reeducate physicians. Too much had been invested to recall the product.

Even I was skeptical at first. However, after seeing marriages ruined, women seeking psychiatric help, and women having to go from doctor to doctor, I realized the problem was real.

Pain, infections, and continued urinary issues are the most common complaints. Pain can be with intercourse and can even affect the spouse. This leads to obvious problems with intimacy. Relationships can be ruined. Pain can also be with movement or exercise. The pain can after right after surgery. Othertimes, it starts 6 to 9 months later after surrounding nerves become entrapped in scar tissue. The pain can be chronic. The vaginal mesh can cause lower back pain.  Women lose interest in social activities. The pain and the inability of doctors to understand compound a woman’s frustration. Urination becomes more urgent or frequent. Some women have to push themselves forward to try to urinate.

Yes. However, we are using mesh for sacrocolpopexy. I use the robot to do this surgery. There should be less risk of problems when the surgery is done this way. Transvaginal mesh for prolapse is something that only high volume surgeons should do. I will use small mesh or transobturator tape slings. We are exploring the use of laser therapy to treat mild incontinence or vaginal atrophy.

Pain is usually improved after surgery. 60% report an improvement. Urinary problems are more difficult to predict. Most women maintain their continence with cough or sneeze. The urgency can get better if it was not a problem prior to surgery. Erosions where the mesh protrudes through the vagina is not an issue once it is removed. We usually recommend estrogen cream as long as there is no breast cancer history. In addition, vaginal laser treatment can be every effective for revitalizing the vaginal tissue.

A listing of different TOT systems

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