Use Of Vaginal Mesh Research Articles

Use of vaginal mesh for pelvic organ prolapse repair: a literature review

The use of mesh for pelvic organ prolapse repair through the vaginal route has increased during this last decade. The objective is to improve anatomical results (sacropexy with mesh seeming better than traditional surgery) and keep still the advantage of vaginal route. Numbers of cohort series and randomized control trials have been recently published. These works increase our knowledge of advantages and risks of mesh. It has been shown that the use of mesh to treat cystocoele through vaginal route improves anatomical results when compared to traditional surgery. The rate of complications, especially de novo dyspareunia, remains equivalent between the two techniques.

Use of vaginal mesh in the face of recent FDA warnings and litigation

Choosing to use mesh in vaginal reconstructive surgery for pelvic organ prolapse or stress urinary incontinence is perplexing in the face of recent US Food and Drug Administration (FDA) warnings. In October 2008, the FDA alerted practitioners to complications associated with transvaginal placement of surgical mesh. Litigation is another concern. A Google search of "transvaginal mesh" results in numerous hits for plaintiff attorneys seeking patients with complications related to use of mesh. In light of a recent decision by the US Supreme Court and strategies by manufactures of medical devices to escape liability, it is imperative that gynecologic surgeons using transvaginal mesh document proper informed consent in the medical records. The purpose of this commentary is not to deter gynecologic surgeons from using transvaginal mesh when appropriate, but to provide an overview of current medical-legal controversies and stress the importance of documenting informed consent.

Insertion and Removal of Vaginal Mesh for Pelvic Organ Prolapse

A variety of surgical meshes are available to correct pelvic organ prolapse. This article discusses benefits and risks of vaginal mesh use. Emphasis is placed on the appropriate surgical technique to improve outcomes and minimize mesh complications. Placement options are reviewed with the discussion of self-tailored mesh, trocar-based mesh kits, and non-trocar mesh kits. This article also reviews the management of mesh complications including the technique for mesh removal.

New Considerations in the Use of Vaginal Mesh for Prolapse Repair

The proliferation of mesh-based transvaginal prolapse surgical repair methods and products has generated increased scrutiny of the evidence-based foundation in support of these techniques. Recent developments in this arena include the publication of the Society of Gynecologic Surgeons Systematic Review Group, which concluded that supportive evidence for transvaginal mesh is limited, and a Public Health Notification from the Food and Drug Administration (FDA), regarding “serious complications associated with transvaginal placement of surgical mesh in repair of pelvic organ prolapse and stress urinary incontinence.” This article reviews available literature regarding transvaginal mesh use, specifically regarding material, technique, and patient characteristics that may influence the rates of iatrogenic complications of transvaginal mesh prolapse repairs. Compliance with the FDA Public Health Notification is encouraged, and additional clinical practice guidelines are provided.

Complications from vaginally placed mesh in pelvic reconstructive surgery

We describe complications associated with the use of transvaginal mesh for treatment of pelvic organ prolapse. We retrospectively identified patients referred to our institution from January 2003 through September 2007 who had complications after vaginal placement of mesh. We identified 21 patients with a mean (SD) age of 61 (11) years. Types of mesh used included mesh kits (n = 9, 43%), nontrocar mesh augmentation (n = 5, 24%), IVS Tunneller (n = 4, 19%), and unspecified (n = 3, 14%). Eleven patients (52%) underwent more than one procedure before referral. Only three patients were referred by the original treating surgeon. Complications included mesh erosions in 12 women, dyspareunia in ten, and recurrent prolapse in nine. Sixteen patients (76%) were managed surgically. Follow-up survey among sexually active patients showed 50% with persistent dyspareunia. Use of vaginal mesh for pelvic reconstruction can produce complications. Multiple interventions may be necessary, and bothersome symptoms may persist.

Mesh‐free anterior vaginal wall repair: history or best practice?

Key content Surgical correction of anterior vaginal wall prolapse is a common gynaecological procedure, with traditional anterior colporrhaphy changing little over the past 100 years. Within the literature, terminology is confusing, both on anatomical structures and classification of anterior vaginal wall prolapse. Synthetic meshes have become available but the evidence to support their use is limited and long‐term adverse effects are not clear. The paravaginal repair is an alternative to consider and can be approached vaginally, abdominally or laparoscopically. Learning objectives To revise the relevant anatomy of the anterior vaginal compartment and the classification of anterior vaginal wall prolapse. To review the evidence for the use of permanent mesh in pelvic floor surgery. To learn about the surgical options for correction of anterior vaginal wall prolapse without the use of vaginal mesh. Ethical issues Should permanent meshes be used for anterior vaginal wall prolapse outside a clinical research setting? Please cite this article as: McCracken GR, Lefebvre G. Mesh‐free anterior vaginal wall repair: history or best practice? The Obstetrician & Gynaecologist 2007;9:233–242.