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Transvaginal Mesh Complications

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Introduction

Transvaginal Mesh is used in various surgical procedures to correct pelvic organ prolapse or any uterine incontinence. In 2016, the FDA reclassified this surgical mesh for transvaginal POP repair as a Class III device as it is an extremely high-risk device and has common complications. Later in  2019, the agency issued an order to all transvaginal mesh manufacturers to cease selling them because it hadn’t proven its effectiveness or safety.

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What is Transvaginal Mesh Complications?

Transvaginal Mesh is a kind of synthetic net-like structure that gives additional support to rehabilitate the damaged or weakened internal tissue. It is implanted during a surgical procedure through the vagina. It is the last resort to treat any stress uterine incontinence- when all the other non-surgical options have failed. Many women suffer from difficulties after they had this surgery. However, Transvaginal Mesh Complications will vary from one woman to another. For some, it might be mild discomfort, and for others, it might be debilitating pain. The complications include:

  • ● Bleeding
  • ● Organ perforation
  • ● Infection
  • ● Pain
  • ● Mesh erosion
  • ● Painful sexual intercourse
  • ● Nerve damage
  • ● Vaginal scarring
  • ● Neuromuscular problems
  • ● Vaginal shrinkage
  • ● Vaginal exposure

What are the Causes of Transvaginal Mesh Complications?

The use of transvaginal mesh or synthetic mesh causes Transvaginal Mesh Ccomplications. Sometimes the mesh will poke through the vaginal wall, and in the process cut through internal tissues causing severe complications like fistula formation, vaginal scarring. In most cases, the non-absorbable mesh made of polyester or polypropylene will wear away or break down over time. Thus, it will lead to the mesh being exposed or protrude through the vagina. In medical terms, this is called vaginal erosion and is a severe complication of using the transvaginal mesh.

What are the Symptoms of Transvaginal Mesh Complications?

  • ● Pelvic swelling or pain
  • ● Irregular vaginal discharge or bleeding
  • ● Experiencing discomfort during sexual intercourse
  • ● Bowel and bladder difficulties such as incontinence and infection
  • ● Sharp stabbing pain or profiling feeling in the vagina, which eventually becomes worse with exercise
  • ● Buttock, lower back, hip, thigh, abdominal, or leg pain
  • ● Blood in the urine due to mesh erosion
  • ● Recurrent urinary infection

How is Transvaginal Mesh Complications Diagnosed?

There are no specific guidelines according to which Transvaginal Mesh Complications can be diagnosed or investigated. This is because the complications and the symptoms have a broad range that can be connected to other uterine/vaginal conditions too. Three non-invasive methods can be used to do the initial investigation. They are:

  1. Medical history.
  2. Physical examination.
  3. Questionnaires.

These tools are easy and form the foundational basis for the next set of tests in the diagnosis. Each complication has a different set of diagnostic tests. All of them are given below:

1. Erosion

  • ● TL, US
  • ●Pelvic MRI
  • ● Urinary tract: US/MRI/urethrocystoscopy

2. Voiding dysfunction

  • ●Cystourethroscopy
  • ● Flow tests
  • ● VUDS
  • ● PVR

3. Pain

  • ● MRI
  • ● TL/US

4. UTIs

  • ● Urinary tract-US
  • ● Cystourethroscopy

5. Hematuria

  • ● CT urogram
  • ● Cystourethroscopy

6. Urinary incontinence

  • ● PVR
  • ● VUDS
  • ● Flow tests

7. Fistula

  • ● Cystourethroscopy
  • ● MRI pelvis
  • ● CT urogram

How is Transvaginal Mesh Complications Treated?

The treatment for Transvaginal Mesh Complications will vary depending on the patient’s circumstances, the comprehensive evaluation after diagnosis, and the patient’s personal preference.

Non-surgical Treatment

  • Pain Management: Professional pain management specialists will help you deal with chronic pains by developing an accurate pain treatment plan customised for you.
  •  Physiotherapy and other physical therapies: Physiotherapy has proven to be useful for a lot of women suffering from this condition. It involves a series of treatments by credible physiotherapists and healthcare professionals who specialise in the female’s pelvis anatomy. It consists of massage techniques, movement therapies, bladder retraining, exercises, and electrical stimulation to alleviate chronic pains. In some cases, occupational therapies- are suggested to help with daily mundane activities.
  • Medications
  1. For pain – Analgesics like ibuprofen and paracetamol
  2. Anti-depressants
  3. Anticonvulsants
  4. Muscle relaxants

Invasive medication treatments include-

  • ● Radiofrequency ablation
  • ● Steroid injections
  • ● Nerve blockers
  • ● Opioids like codeine, morphine, and oxycodone

If the patient is experiencing mood disorder symptoms, for instance, depression disturbed sleep, anxiety, etc., then along with medications, psychotherapy, and counselling is recommended.

Surgical Treatment

Surgery can be performed to permanently remove the transvaginal mesh from the pelvis. However, surgery is only possible if the mesh or the scar tissue around it makes it safe to remove. Not all gynecologists and urologists are qualified to perform this surgery. Furthermore, there are chances you might need more than one surgery to completely remove the mesh. Other surgeons like orthopaedic and plastic surgeons may be involved in the surgery too.

What is the Results of Transvaginal Mesh Complications Treatment?

It is advised against getting the surgery to place a transvaginal mesh in your pelvis in the first place. It has been withdrawn in Australia to treat pelvic organ prolapse like bowel, uterine, and bladder. In November 2017, the Therapeutic Goods Administration rescinded all the products used for this surgical procedure from the Australian Register of Therapeutic Goods. However, if you already got the surgery, then it is recommended you try nonsurgical treatment methods to correct the Transvaginal Mesh Complications. Opting for surgery might not be feasible, and it will only make your condition worse.

What are the Risks Associated with Transvaginal Mesh Complications treatments?

Removing the mesh can have severe risks. Some of them are-

  • ● Damage to the internal organs, blood vessels, and nerves.
  • ● It can deteriorate your prolapse condition.
  • ● Make symptoms such as incontinence and pain worse.
  • ● Develop new painful symptoms.

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FAQ's

Will Surgery Help to Correct Transvaginal Mesh Complications?

Surgery to remove the Transvaginal Mesh will not necessarily solve all your complications and symptoms. Proper post and pre-op care should be taken to manage the existing and new symptoms.

What Does Extrusion of Mesh Mean?

When the synthetic mesh utilised during the surgical repair erodes through the skin’s soft tissues and is exposed via the vagina.

What are Some Symptoms of Bladder Sling Problems?

  • ● UTIs
  • ● Painful sexual intercourse
  • ● Urinary retention
  • ● Urge incontinence

What are Some Symptoms of Mesh Rejection?

  • ● Scar tissue
  • ● Sepsis
  • ● Chronic pain
  • ● Inflammation
  • ● Infection

What are the Alternatives to Mesh for Prolapse Treatment?

  • ● Bladder training
  • ● Vaginal pessary
  • ● Pelvic floor physiotherapy

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