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Mesh In Treatment Of Pelvic Prolapse And Gynelogical SurgeryMy Opinions: Dr. John F. McNamara Jr., MD, Randolph OB/GYNPelvic Organ Prolapse Mesh, made of a soft synthetic fiber material, has been successfully used to treat abdominal defects for many years without significant complications. Use in gynecological surgery is different, in that we are dealing with thinner tissues and tissues exposed to the normal vaginal bacteria and impact of intercourse. Mesh can be used for surgical repair of: • Uterine prolapse • Bladder prolapse • Vaginal prolapse • Rectal prolapse • Other medical or health needs as determined by your physician The need for mesh arose out of high failure rates for certain types of surgery and other techniques to repair pelvic defects. Some have had as high as a 45% failure rate. One area where mesh is being used today is the treatment of difficult forms of pelvic organ prolapse. This occurs when an organ in the pelvic area such as the bladder or bowel drops (prolapses) from its normal position and pushes against the vagina or other organs in the area. This can cause discomfort, painful intercourse, protrusions and other problems. Use of mesh in gynecology is evolving. We are learning every year. Meshes used today are far better than those used just a few years ago. They are much smaller and have better ways of attachment. We are also learning better surgical techniques. Mesh erosion rates in the past have been as high as 18%, but now with newer meshes they are around 4-5%. Most erosions are minor, but not all. Pelvic pain, nerve pain and painful intercourse are also potential complications. As with many medical conditions and treatments, no solution is perfect.As a gynecological surgeon who has performed many operations involving mesh as well as other procedures to treat pelvic prolapse, I do not think that a surgeon should routinely use mesh for all prolapse surgery. I think the physician must be selective. Use for recurrent prolapse, when one cannot find adequate tissue, and certain defects that are known to have a high failure rate, are where mesh should be carefully considered. Otherwise, a good pelvic surgeon ought to be able to repair most pelvic organ prolapse without mesh. Urinary Incontinence Procedures The FDA has not commented on the use of suburethral mesh for treatment of urinary incontinence. There are many years of data, which in my opinion support the use of this mesh on a routine basis. This is different than use for pelvic organ prolapse. Selecting A Surgeon Make sure you select a surgeon who has expertise in surgery for pelvic organ prolapse. Ask questions, particularly about the use of mesh. To learn more, contact Randolph OB/GYN using our online contact form, or call 704-333-4104 and ask for an appointment with a physician specializing in pelvic prolapse.
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