Saturday, May 9, 2009

Mesh Complications and Vaginal Surgery: Part 1

In all realms of medicine, advancement in patient care is a learning process, with the ultimate goal being better patient care. New technologies abound, and scientists and physicians are often at the cutting edge to adapt these technologies to patients through experiments in the labs and trials in the real world. However, new technology comes with responsibility and proper patient counseling prior to any procedure helps to define the risks and benefits of all surgeries, including those involved in mesh repair of hernia throughout the body.

Mesh is a common and safe synthetic product that can be surgically placed in many areas throughout the body to reinforce a hernia or defect that occurs over time or as a result of injury. The classic example is a groin or inguinal hernia in a man. It is painful and can occur in 10% of men, usually after repetitive straining. A mesh patch or plug is placed through a small incision and reinforces the weak tissue and significantly reduces recurrence rates. It has been widely adopted by general surgeons over the last 2 decades.

Repairing or lifting dropped pelvic organs have been common surgeries in women. The most common is the bladder (cystocele), but the uterus, small intestine or rectum can also drop and push out the vagina. It can be painful and lead to urinary and defecatory problems, pain with sex, and other issues. Many surgeries have been devised to “lift” the bladder, but unfortunately, recurrence rates for cystocele repair is quite high, approximately 30% at 4 years. It is the most common organ to drop after hysterectomy. Naturally, mesh has been considered to reinforce these repairs to reduce recurrence rates and prevent an unnecessary second and even third operation.

Many types of mesh exist, and not all mesh are created equal, nor appropriate for the vagina. Some mesh are synthetic and others are biological, from human or animal. The ultimate questions when approaching a patient with pelvic floor weakness, such as stress incontinence or bladder drop, are: Is surgery indicated, what type of surgery is indicated, what are the alternatives, how is the surgery to be done, and what are the complications that go along with it, is the surgeon comfortable and highly trained to perform it, and is the patient’s condition appropriate in order to place mesh?

There has been an explosion and revolution in women’s pelvic health in the last decade and many mesh products are available to the physician to choose from to fix incontinence and dropped organs. Subjects that older women were embarrassed to discuss are now out in the open, and since women are living longer and healthier with more active lifestyles, there is a demand for sustaining and improving quality of life in regards to the bladder. Incontinence affects a woman’s self esteem, and is restricting. Women often will stay at home in order to avoiding embarrassing odor or accidents in public, will not socialize and avoid sex. It’s a common an underreported problem with less than half of women even bringing it up for discussion with their family doctor.

The TVT (tension-free vaginal tape) mainstreamed mesh into common use for correcting stress incontinence. It has been on the market since 1996 with millions done worldwide. It is relatively easy to place, is minimally invasive, has a short recovery period and a low complication rate, and high success rate. Most urologists and gynecologists now use some type of TVT copycat to treat stress incontinence.

The question is then asked, can mesh for bladder repair, or other pelvic organs do the same thing?

1 comment:

John said...

Great article. I read a comparison between laparoscopic Burch colposuspension, the most widely used procedure before TVT, and the new tension free vaginal tape surgery. The conclusion was very clear, the TVT surgical mesh procedure outperformed Burch, providing better results and lesser recurrence rates. On top of that the TVT procedure is more cost effective and easier to learn by surgeons.