The Question of Transvaginal Mesh

By Elizabeth Ferry, MD

Ferry
Ferry

Mesh implants have been used for over 50 years in a variety of different surgeries. Generally, they are implanted to provide more support in a weak spot of the body, such as a hernia.

In the early 1990s, pelvic surgeons started using mesh as a sling to support the urethra and prevent stress urinary incontinence. Stress urinary incontinence is any unwanted leakage of urine during activities such as laughing, sneezing, or coughing.

Later on, larger pieces of mesh were also used to support the bladder during a surgical repair for prolapse, or “dropped bladder.” The mesh was placed through the vagina (transvaginal mesh) in both cases to provide a stronger repair, while also decreasing operating and recovery time.

In July 2011 the FDA issued a safety communication expressing concern for an increase in the number of women having complications following surgery using transvaginal mesh. A thorough review was performed, and ultimately it was determined that transvaginal mesh used for prolapse repair had a higher than expected rate of complications, such as infections, pain, and erosion of the mesh. The mesh kits used for prolapse were repairs were subsequently reclassified as “high-risk” devices.

The mesh slings used for stress urinary incontinence were also closely reviewed by the FDA, but determined to be both safe and effective. This position was shared by The Society of Urodynamics and Female Urology (SUFU) and the American Urogynecologic Society (AUGS). These organizations released a shared statement in 2014 acknowledging the mesh sling’s safety and success rates, as well as the procedure’s ability to help “millions of women with stress urinary incontinence” with “a simple outpatient procedure that allows them to return to daily life very quickly.” The difference in the safety of the mesh procedures is thought to be due to how and where the mesh is placed, rather than the mesh itself.

“Urine leakage is not a condition that women ‘just need to deal with,’ and while a mesh sling may not be the best treatment for every woman, it is a great option for some.” said physician Natasha Ginzburg, assistant professor of urology and director of female pelvic medicine and surgery at Upstate Urology.

Before any surgical procedure, you should discuss all the potential risks and benefits with your doctor, and work together to find the treatment that works best for you.

Physician Elizabeth Ferry is a Watertown native. She completed medical school at SUNY Upstate and urology residency at Case Western Reserve University in Cleveland, Ohio. She is currently an assistant professor of urology in the department of urology at SUNY Upstate Medical University, specializing in female and general urology.

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