Since 1990, vaginal mesh surgery has been used worldwide by many physicians as a treatment of choice for Pelvic Organ Prolapse (POP) and Stress Urinary Incontinence (SUI). It is defined as the insertion of a surgical mesh into the walls of the vagina to support the pelvic muscles that hold the vaginal wall and the pelvic organs in place.

Pelvic Organ Prolapse (POP) happens when the pelvic organs such as the bladder, urethra, uterus,and rectum are displaced due to the weakening of the connective tissues that support the walls of the vagina.  The most usual among the different types of prolapse are: bladder prolapse, urethrocele (prolapse of the urethra), uterine proplase, and rectocele (prolapse of the rectum).  Stress Urinary Incontinence (SUI) is known as the uncontrollable leaking of urine from the bladder in involuntarily induced movements like coughing or sneezing.  This is caused by the weakening of the muscles of the pelvis.   Both POP and SUI occur mostly to adult women whose vaginal walls have been stretched and weakened like in cases of parity, hysterectomy, and menopause. These two medical conditions: POP and SUI mostly develop in adult women who have had menopause, hysterectomy procedures, and even childbirth.

How do physicians perform this operation? How is this surgical procedure carried out? Firstly, an incision is made to gain access inside the vagina, and then the tissues that support the vaginal wall will be strengthened with stitches.   A vaginal mesh is then inserted firmly under the vaginal skin and stitched intact. Designed with many holes, this medical device allows the body tissues to easily grow into it 3 to 4 weeks later.  The incision made to the vagina earlier is then stitched back to close. An additional stitch at the top of the vagina or the cervix (sacrospinous stitch) may be required by some doctors for stronger support.   This stitch, however, can cause an uncomfortable feeling in the buttocks that could stay for 3 months. A urinary catheter and a material pack are lodged in position at the end of the surgery; these two can then be removed after one or two days.

Deadly complications associated with this surgery are most likely to happen, so careful observations should be done during the surgery and the recovery phase.  In the past years, the U.S. Food and Drug Administration (FDA) is continuously overwhelmed with an increasing number of complaints about vaginal mesh products.   The most common reported complications are: mesh erosion, bleeding, infection, recurrence of prolapse, urinary problems, and pelvic organ perforations.   These symptoms are tricky since they begin as mild symptoms and then advances to more serious complications. Some of these complications are impossible to treat, and some have caused deaths to a few recipients.  In fact, because of these deadly complications thousands of lawsuits were filed by many recipients against mesh manufacturers all over the United States recently.

If you are one of those women considering vaginal mesh surgery for the management of POP or SUI, or if you know someone who is planning to receive this treatment, ask your doctor detailed information about your surgery, most importantly about the possible complications this procedure may bring about.

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.