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Vaginal mesh is a surgical mesh made of synthetic medical-grade material, similar to netting used for grafts. Mesh is used for abdominal (stomach) and groin hernia repairs and provides support when a person’s own body tissue is not supportive enough, which can be due to a variety of reasons.
Most patients (approximately 90%) do very well with mesh. However, the associated risks include the following:
- Exposure: this is one of the most common problems and affects up to 10% of patients. Exposure, also sometimes called erosion or extrusion, is when the mesh protrudes into your vagina, bladder or bowel. This painful complication is related to healing problems and infection at the site of the mesh and can take years to arise. Symptoms of this complication depend on where the exposure occurs. Vaginal exposure is associated with symptoms such as discharge from your vagina, and pain during intercourse (dyspareunia). Bladder/urethra exposure can cause pain when urinating, reoccurring cystitis, the development of bladder stones, blood in your urine (haematuria), an urgent need to go to the toilet (urgency) or a urinary fistula (an abnormal opening in an organ of the urinary tract or an abnormal connection between a urinary tract organ and another nearby organ). Bowel symptoms can include difficulty pooing, bleeding in the rectum or the formation of fistula (abnormal openings or connections).
Risk factors for exposure include age, lack of oestrogen, scarring of the vagina from previous surgery, diabetes, steroid use and smoking. Treatment is dependent on both where the exposure is located and how large it is. Treatment may be a combination of antibiotics and oestrogen replacement along with surgery to remove part or all of the mesh.
- Infection: affecting 0- 8% of patients. The symptoms of an infection include pain, discharge, bleeding, pain during intercourse, and incontinence (bladder or bowel). Risk factors include BMI, diabetes, steroid use and smoking. If you get an infection, you will be given antibiotics and the infected mesh may be removed. NB. Intravenous antibiotics are given during the sling surgery to prevent infection.
- Failure rate: 10-15% failure rate resulting in recurring prolapse or incontinence.
- Dyspareunia (painful intercourse): approximately 9% of patients experience painful intercourse, which may be caused by mesh exposure, infection, retraction or fibrosis of the vaginal tissue (scar tissue). Treatment may require physiotherapy and/or removal of the mesh and the scar tissue
- Bleeding: major bleeding during or after the surgery is uncommon (1%) but in the event of such an occurrence you may need a blood transfusion.
- Damage to the internal organs (bladder, ureters, urethra, bowel, and blood vessels): there is a slight risk of organs in the surgical are being damage, which would require further surgery.
- Blood clots: there is a <1% risk of blood clots in the legs or lungs.
- There are also risks associated with a general anaesthetic which the anaesthetist will discuss with you before your operation.
- If you are post-menopausal and there is evidence of atrophic vaginitis (thinning of your vaginal tissue), using topical oestrogens prior to your surgery may help. Your consultant will talk to you about this.
- Stopping smoking several weeks before a surgery reduces your chances of complications such as exposure, infection, blood clots and helps you to recover better.
- You may need to stop taking blood thinning medication such as Aspirin, Plavix (clopidogrel), Warfarin (coumadin) or Xarelto (rivaroxaban) – please inform your consultant if you are taking any of these, who will advise if you need to stop taking them.
- Try to maintain a healthy weight or lose weight if you are overweight.
- Get your blood sugars to their optimal level if you are diabetic.
- Avoid constipation.