Pelvic Organ Prolapse (POP) and Stress Urinary Incontinence (SUI) are two dangerous conditions many adult women from all over the world are suffering from.   These can be uncomfortable or painful, but they don’t worsen if treated properly.   Adult women and those who have had past vaginal deliveries are usually exposed to these.

A system of connective tissues spread over the vaginal wall to keep the organs in the pelvic area intact.  These connective tissues stretch and weaken resulting to the displacement of the pelvic organs in POP and SUI.   The symptoms include pressure felt in the vaginal wall or groin region, lower back pain, constipation, pain during sexual intercourse, and incontinence. 

A surgical procedure called trans-vaginal mesh (TVM) implantation is done and indicated only for patients with symptoms.  This is done by implanting a medical device called surgical mesh into the vagina to support the vaginal area in POP or to strengthen the urethra to manage SUI.  TVM surgery can bring about unpleasant consequences in the future, so proper management is needed.  Before performing the procedure, physicians should discuss it with their patients and tell them about the possible risks involved.  An informed consent should be secured from the patient documenting their full understanding of the procedure. 

How do surgeons perform TVM Implantation?  A general or spinal anesthesia is given to the patient; then the doctor makes an incision in the vagina and stitches the vaginal wall to strengthen it.  The mesh is positioned and stitched securely into the vaginal wall.   After 3 to 4 weeks, the mesh is absorbed into the body since it is built with many holes for the body tissues to grow into them.   It reinforces the vaginal tissues.   The physician then stitches the incision that was previously made in the vagina. An additional stitch called sacrospinous stitch may be done into the cervix or at the top of the vagina for a better support. For a stronger support,  sacrospinous stitch is done at the top of the vagina or into the cervix.  Patients might experience discomfort in the buttock for up to 3 months after the surgery with the final sacrospinous stitch. At the end of the procedure, a catheter is then inserted into the bladder for the drainage of urine, and a vaginal pack is lodged into the vagina to prevent bleeding.   These may be removed after one to two days. 

Some physicians recommend inserting a vaginal support device (VSD) at the end of the procedure.   VSD has a soft material and it makes the vaginal wall more secure during the reparative stage after the surgery.  Four weeks after the date of the surgery, it, can be safely removed. 

After the surgery, pain medication and antibiotics are prescribed by the physicians.  There is also the need to avoid any strenuous activities for 6 to 12 weeks. 

Complications like bleeding, infection, and pulmonary embolism can occur during the surgical procedure.  These conditions can become seriously dangerous, that’s why there is a need for an informed consent.  Never hesitate to ask for more information from your doctor about this surgical procedure and its possible risks.