Vaginal Mesh Complications
Vaginal Prolapse anaphase Non-mesh (autologous) sacrocolpopexy / sacrocolpopexy
A strip of the abdominal wall is used instead of mesh to attach the top of the vagina or uterus to the ligaments on the front of the sacrum (tailbone). This offers women an alternative to the use of synthetic mesh (see Mesh Complications for discussion of mesh risks)
Important Patient Information
The use of mesh in operations to treat prolapse and incontinence has received a great deal of media attention recently. We understand that this may have caused anxiety and uncertainty for women and their families.
‘Mesh’ is a term used to describe man-made materials that are implanted in the body during surgery. Mesh was introduced in Gynaecology and Urology to try and improve the effectiveness of some procedures for prolapse or incontinence. Like all surgery, mesh surgery has risks. These risks need to be balanced against the potential benefits of surgery, and the alternative treatments available.
London Urology Specialists currently offer the following mesh procedures:
- Mesh sacrohysteropexy for prolapse of the womb
- Mesh sacrocolpopexy for vaginal prolapse after hysterectomy
- Mesh midurethral slings for urinary incontinence, also know as tension-free transvaginal (TVT) tapes and transvaginal obturator (TVTO) tapes.
All of the above procedures have been reviewed and approved by the National Institute for Health and Care Excellence (NICE). NICE provide guidance for NHS staff and patients on the safety and effectiveness of treatments.
There have been several national and international reports on the safety and effectiveness of mesh surgery for prolapse and incontinence. These include the Scottish Government Independent Report and the NHS England Mesh Oversight Group Report, both published in 2017. These reports concluded that the procedures we offer at UCLH are safe and effective. A third European Commission report on the safety of surgical meshes made similar recommendations.
The risk of mesh complication depends on which particular surgical method is used. Guidelines currently under development by NICE have recommended that mesh inserted through the vagina to treat prolapse should not be used except in medical research. This recommendation has been made because prolapse mesh implanted through the vagina, carries a higher risk of complications than other techniques. We do not use mesh inserted through the vagina to treat prolapse.
Specific risks associated with mesh surgery include vaginal exposure or erosion into nearby organs. Vaginal exposure means that the mesh becomes visible (palpable) in the vagina. Erosion means that the mesh has eroded through the wall of the bladder or bowel. These complications might cause pain, infection, or other symptoms, and often require additional treatment, including surgery.
The risk of mesh complications depends on the particular type of surgery performed. Our technique of mesh sacrohysteropexy has been used to treat prolapse of the womb for ten years. To our knowledge, no cases of mesh exposure or erosion have been reported in our patients. London Urology Specialists also offer autologous sacrohysteropexy and sacrocolpopexy (see section on Prolapse), and autologous rectus facia slings (see section on Stress Incontinence), which use the patient’s own tissue rather than synthetic mesh for patients who would prefer to avoid the risks of mesh implant
Sacrocolpopexy and midurethral sling surgery are known to be associated with mesh complications. Vaginal mesh exposure probably affects around 5 in 100 (5%) women after sacrocolpexy. It seems to be less common after midurethral sling surgery, affecting around 2 in 100 (2%) women. Mesh erosion into the bowel or bladder is much less common and probably affects around 1 in 1000 (0.1%) women. The risk of these problems needs to be balanced against the potential benefits of surgery, and the risks and benefits of non-mesh operations.
All surgical procedures for prolapse and incontinence can be associated with complications, which may occur whether mesh is used or not. Problems include pelvic and vaginal pain, painful sexual intercourse, new or worsening bladder and bowel symptoms, or failure of the operation. All of these complications may require additional treatment, and this might include further surgery.
There have been claims that mesh implants may cause autoimmune disease, such as rheumatoid arthritis. Studies have compared women who had non-mesh surgery with those who had mesh surgery, and men who had mesh hernia surgery with healthy volunteers. These studies monitored over 30,000 patients and 70,000 healthy volunteers for up to six years and no link was found.
All patients at London Urology Specialists are offered a complete range of non-surgical treatments as well as surgical procedures to help with your symptoms. We provide detailed information leaflets and counselling to all patients. Your surgery will be discussed and approved by a team of specialists at a multidisciplinary team meeting (MDT) before any surgery is performed.
All of our mesh procedures are recorded on a national database to monitor the quality and safety of our surgery, and to identify any complications. We also report any mesh complications to the Medicines and Healthcare Regulatory Authority (MHRA). Reporting problems will help us to understand how common complications are long term. This is important because most research has only monitored patients for around five years after surgery.
If you have any further questions, do not hesitate to ask a member of our team. You can find out more about the risks and benefits of surgery from our range of patient information leaflets.
Patient information leaflets available online
Chughtai B, Sedrakyan A, Mao J, et al. Is vaginal mesh a stimulus of autoimmune disease? Am J Obstet Gynecol 2017;216:495.e1-7. http://www.ajog.org/article/S0002-9378(16)46210-1/fulltext
Chughtai, B., Thomas, D., Mao, J. et al. Hernia repair with polypropylene mesh is not associated with an increased risk of autoimmune disease in adult men. Hernia 2017; 21: 637-642. https://link.springer.com/article/10.1007%2Fs10029-017-1591-1
European Commission SCENIHR Opinion on the safety of surgical meshes used in urogynecological surgery,December 2015. https://ec.europa.eu/health/sites/health/files/scientific_committees/emerging/docs/scenihr_o_049.pdf
Ford AA, Rogerson L, Cody JD, Ogah J. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database of Systematic Reviews 2015, Issue 7. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006375.pub4/full
NHS England Mesh Oversight Group Report, July 2017. https://www.england.nhs.uk/publication/mesh-oversight-group-report/
NHS Synthetic Vaginal Mesh Tape Procedure for the Surgical Treatment of Stress Urinary Incontinence in Women, Patient Information Leaflet, May 2017. http://bsug.org.uk/budcms/includes/kcfinder/upload/files/info-leaflets/SUI Mesh Tapes Leaflet Version 24_160517 BSUG RCOG logo v2.pdf
NICE recommendation for uterine suspension (including hysteropexy) for uterine prolapse, June 2017. https://www.nice.org.uk/guidance/ipg584/informationforpublic
NICE recommendation for sacrocolpopexy using mesh for vault prolapse, June 2017. https://www.nice.org.uk/guidance/ipg583/ifp/chapter/What-has-NICE-said
NICE Urinary incontinence in women: management (Clinical Guideline CG171), November 2015. https://www.nice.org.uk/guidance/cg171/ifp/chapter/Surgery-for-stress-incontinence
Scottish Government Independent Report, March 2017: http://www.gov.scot/Publications/2017/03/3336/downloads – res-1