Keywords: Pelvic organ prolapse, prolapse surgery, vaginal mesh repair, surgical mesh, transvaginal mesh complications, vaginal mesh infection. Pelvic organ prolapse:
Prolapse is the medical term employed when the pelvic organs of the body such as the uterus, cervix, vagina, urethra, bladder and rectum prolapse owing to the loss of their natural supporting ligaments and muscles. This is a serious condition and can virtually involve many complications, thus justifying some effective treatment.
Prolapse surgery: Although some non-surgical modalities are also available, the only reliable option is the surgery. Among surgical options the surgeon can either go for a repair with a surgical mesh or he can opt for the strengthening of patient’s native weak muscles and ligamentous supports.
Depending on the type of organ prolapsed and the extent of prolapse, colporrhaphy for bladder and urethra, vaginal hysterectomy for uterus alone, sacrocolpopexy and sacrospinous ligament fixation for uterus and vagina, and posterior repair for vagina and rectum, can be employed. These may be carried out through vaginal, abdominal or laparoscopic approach.
All these procedures may or may not be augmented by the use of a vaginal mesh implant. The mesh works by the foreign body effect, causing a fibrosis in the surrounding structures and thus providing them the desired strength.
Transvaginal mesh complications: Although the vaginal mesh implants provide the needed support to the prolapsed organs, their use never goes without complications. Some of them are particularly dangerous and so have lead to controversies regarding their use. Described in the following paragraphs, are the five most frequent complications arising from transvaginal mesh placement.
Failure of the Transvaginal mesh procedure: This happens to be the worst scenario of the case when the selected procedure doesn’t work on the particular patient. Some patient’s internal anatomy does not justify the use of a mesh and if that has been done forcefully, then the procedure is liable to fail.
Pain assicated with the transvaginal mesh procedure: Like every other surgery, pain is an undesirable effect of the procedure. Severe pain in vagina, leg, pelvis and lower abdomen is a frequent sequel of mesh placement. This can be treated with painkillers; however the chronic nature of the pain sometimes makes it difficult to bear with. This is usually a result, either of the impingement of the fibrotic material on the nerves in the pelvis, or of the direct trauma during surgery.
Infection of the graft in a transvaginal mesh procedure: This is not an uncommon thing to happen owing to the fact that the graft material is foreign and can easily get infected. Type 1 macroporous soft propylene mesh has been found to have the lowest incidence of infection. This side effect manifests itself with pain, fever and leukocytosis on lab findings, and if not treated promptly can lead to sepsis.
Extrusion of the transvaginal mesh: The vaginal mesh if not sutured properly, can be extruded transvaginally, giving rise to the symptoms of pain, discharge and bleeding through the vagina. The bleeding can be particularly troublesome and may need transfusion support. The mesh in this case is to be removed while securing adequate hemostasis.
Erosion of the transvaginal mesh: Last but not the least is the erosion of the surgical mesh into the surrounding structures of bladder, rectum, bowel and urethra, with the formation of fistulae. This is a grim complication and requires the reversal of the fistulae through surgery.