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Pelvic Surgery

Mesh in Pelvic Surgery: An Expert Offers Insights

If you're a woman facing pelvic surgery, you may be concerned by reports of the risks of transvaginal mesh. Chances are, you’ve heard more about the risks than any benefits. So what is it, and when is it used? Is mesh in pelvic surgery ever a good choice?

Surgical mesh has been used for decades. It’s frequently used to treat two common conditions in women: stress urinary incontinence and pelvic organ prolapse. Stress urinary incontinence is the leaking of urine when coughing, sneezing or jumping. In pelvic organ prolapse, organs in the pelvis, such as the bladder, rectum or uterus, drop down into the vagina.

The Controversy

The Food and Drug Administration (FDA) issued warning statements in 2008 and 2011 regarding transvaginal (through the vagina) mesh placement to treat pelvic prolapse. However, the warnings did not address mesh placed laparoscopically (through small incisions using a camera for guidance). And it also did not address use of mesh to treat stress urinary incontinence. Both these procedures have high success rates and low complication rates.

But law firms have not always made this distinction when seeking clients with mesh complications. The American Urogynecologic Society and the Society for Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction tried to clear things up with a position statement to support the use of mesh for stress urinary incontinence. But many women, and even physicians, are still confused and concerned about any use of mesh in pelvic surgery.

Our Expert Weighs In

“There are a lot of myths out there,” says Savitha Krishnan, MD, a urogynecologist specializing in female pelvic medicine and pelvic reconstruction surgery for women at El Camino Hospital.

Dr. Krishnan performs about 20 surgeries for stress urinary incontinence and about 20 for pelvic organ prolapse each month. She uses a lightweight, polypropylene synthetic mesh, much different from the denser meshes used in the past. The body uses the mesh as a scaffold, with tissue growing into and around the mesh. Some older types of mesh and procedures were more likely to result in the mesh becoming exposed and causing symptoms.

For stress urinary incontinence, Dr. Krishnan says mesh is one of the best options. “In fact, 85 to 90 percent of patients never leak with coughing, sneezing or jumping again. And it’s an outpatient procedure so patients can usually go home the same day,” she says.

For pelvic organ prolapse, Dr. Krishnan rarely places mesh transvaginally — that’s the use the FDA warnings referred to. But for a few patients with severe prolapse and other issues, it’s the best choice.

What if you’ve already been treated with transvaginal mesh? Dr. Krishnan says you most likely don’t need to take any action.

“I have rarely had to remove mesh for exposure, pain with intercourse, or any other issues — probably less than 20 in 2,000 cases. In only about 1 percent of cases does mesh need to be removed because it becomes exposed and causes problems. Even then it usually only needs to be partially removed, and the patient remains continent,” Dr. Krishan says.

“If you’ve had a prolapse procedure using mesh and are doing well, that mesh has not been recalled. Usually there are no problems,” she continues.

Her advice to any woman with stress urinary incontinence or pelvic organ prolapse is to seek an experienced specialist who frequently treats these conditions.

“Don’t let the litigation or warnings scare you,” she says. “Find an experienced physician, and just see what the options are — because quality of life really improves after a lot of these stress urinary incontinence and prolapse procedures. There are treatment options that don’t use mesh, but you need to know the pros and cons. That’s why it’s important to seek advice from a doctor who does a lot of these procedures.”

To find out more about treatment for pelvic organ prolapse or stress urinary incontinence at El Camino Hospital, visit us online. El Camino Hospital can assist you in finding a provider that can provide you with all treatment options, and support you in making informed decisions about your health.

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