Controversy About Vaginally Implanted Mesh
Marja Sprock, M.D.
Turn on your TV and you
will hear ads to contact a lawyer if you have had an
implant of vaginal mesh. Open the newspaper and you will
read the latest FDA warning about vaginally implanted
mesh. This might make you wonder why we even use those
meshes. As with every story, there are two sides. As a
urogynecologist and skilled vaginal surgeon, I use
vaginally implanted meshes and will continue to do so
when they give the best alternative for a patient's
So why would a surgeon
with all this threatening material coming out still
insert vaginal meshes. The answer can be short, because
there is an indication and advantage to using them in
A fact that gets often
overlooked is that a mesh does not get inserted in a
normally supported vagina with strong healthy tissue.
Meshes are, and if used
correctly should only be used in severely prolapsed
(descended from the normally supported position)
vaginas. If the support is broken and the tissue is very
weak, it has been proven by combining several studies,
that the longevity of the repair is better with a mesh
on the front wall of the vagina. Some of the problems
cited in the July 13th 2011, FDA warning are excellent
to be aware of, however are not only a problem with the
vaginally placed mesh repairs, but also with non-mesh
The FDA reports
complications with mesh repair as vaginal extrusion of
mesh, erosion, sexual dysfunction, urinary tract injury,
pain and other complications. It is essential to
recognize that many of these complications are known to
occur with and without mesh repair. And maybe even more
importantly, mostly surgeries turn out to be “the best
thing I ever did and wished I had done it years ago”
event. A severely prolapsed vagina can cause
debilitating problems, varying from being up the whole
night to urinate, lower back pain, continuous pressure,
and difficulty having a bowel movement or urinate,
inability to have intercourse, recurrent urinary tract
infections, and inability to exercise due to discomfort
to keep on adding.
Any surgery, be it on
your vagina, your nose, shoulder or knee, has risks.
Mesh repair may improve long-term anatomic results of
surgery as compared to non-mesh repairs for some
prolapse, but the debate is out how good does a repair
need to be for a patient to feel better. A lot of
studies nowadays are focused on does the patient feel
better and often the repair does not make the A+ mark.
Meshes were introduced into vaginal surgery because of
the high failure rate of conventional repairs, lowering
the bar may make non-mesh repairs appear to be just as
good, but what about long-term?
In all honesty I see a
fair amount of patients in consultation who have
undergone a repair without mesh, where such an extreme
amount of tissue was removed that they will never be
able to complain about sex with intercourse, since they
have barely a vagina left. On a monthly basis I see more
women with difficulty after a vaginal repair without
mesh for an initial appointment than with. Obviously
some women have been faced with significant problems
after either repair, so choose your surgeon wisely.
Surgeons require rigorous training of pelvic anatomy,
mesh implantation techniques and recognizing which
patient would and would not benefit from surgical repair
and use of a mesh. Experienced high volume surgeons have
persistently better outcomes in a wide array of
specialties and surgeries.
Treatments for vaginal
prolapse are numerous and vary from exercises to
pessaries (intra-vaginal support devices) to surgery.
Surgeries can be through the vagina or abdomen. The
abdominal surgeries are mostly performed with a
laparoscope or a robot. Treatment choice depends on the
severity of the prolapse, the severity of bother and the
age and mobility, as well as health and desire for
sexual activity of the patient.
Example of one
square inch of an open weave mesh pattern that
is currently being used in some vaginal prolapse
Meshes have improved
significantly over the years. If your vaginal prolapse
was repaired with a vaginally placed mesh and you are
happy with your repair and have resumed all regular
activities, you are in the majority.
For the people who have
a bothersome prolapse and are considering repair, do
your homework. a urogynecologist, especially one who has
done advance fellowship training, has chosen this
subject as one of their areas of expertise. I often get
a laugh when I state “I fix vaginas for a living”;
however it is an art that should be taken seriously.
Read the FDA safety
communication and ask questions. I have included a
link to the FDA communication (click
here) and a report that I and many other
skilled surgeons have signed that lists our comments on
the FDA report.
here for our reply.
We use the AMS Elevate
Prolapse Repair system.
Click here for a
brochure from AMS that talks about the prolapse problem
and the Elevate solution.
My goal is an A+ repair
and it depends on the patient and her tissue quality how
I will attempt to achieve it. Sometimes we have to
settle for a B and the patient is very pleased.
The future will tell us
if A+ were wiser than B’s, let’s try to prevent the E’s
and F’s though.
Marja Sprock, MD is a fellowship trained urogynecologist
under David Richardson, MD at Henry Ford Hospital in
Detroit. Her practice, Central Florida UroGynecology, is
in Rockledge, FL.
Please call for an
appointment at 321-806-3929,
send us a
note or visit us online at