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Gynecologic Mesh
Sherri F. Caplan, DO
Health First Ob/Gyn
February 2013
What is Mesh?
• According to the FDA, surgical mesh is a medical device that is generally used to repair weakened or damagd tissue; it is made from porous absorbable or non-absorbable synthetic material or absorbable biologic material.
Types of Mesh
• Synthetic
– Polypropylene, gortex
• Biologic
– Autologous (self—abdominal fascia or tensor fascia lata)
– Fetal bovine
– Porcine
Indications
• Vaginal Vault Prolapse
• Uterine Prolapse
• Symptomatic Cystocele
• Symptomatic Rectocele
• Stress Urinary Incontinence
• Paravaginal Defects
Cystocele
Complications
• Mesh erosion (most common 5-19%)
• Vaginal mesh extrusion
• Perforation into bladder or bowel
• Bladder or bowel fistula
• Abscess
• Dyspareunia
• Reoperation (1-7.6%)
• Failure
Why all the lawyer commercials?
• The FDA Safety Communication and Update on the use of transvaginal mesh for the repair of pelvic organ prolapse made some recommendations to health care providers
• Obtain specialized training for each mesh placement technique and be aware of the risks of surgical mesh;
• Be vigilant for potential adverse event from mesh, especially erosion and infection;
• Watch for complication associated with the tools used in transvaginal placement, especially bowel, bladder, and blood vessel perforation;
• Inform patients about the potential for serious complications and their effect on quality of life, including pain during sexual intercourse, scarring, and narrowing of the vaginal wall in pelvic organ prolapse repair using surgical mesh;
• Inform patients that implantation of the mesh is permanent and that some complications associated with the implanted mesh may require additional surgery that may or may not correct the complication;
• Mesh placed abdominally for pelvic organ prolapse repair may result in lower rates of mesh complications compared to transvaginal surgery with mesh
In Conclusion
Transvaginal mesh is an excellent option to correct pelvic organ prolapse in some individuals.