Vaginal Mesh Erosion and Surgery
In October 2008, the U.S. Food and Drug Administration issued an announcement about the danger of Trans-vaginal Mesh (TVM) implantation. TVM is typically used to treat Pelvic Organ Prolapse (POP) and Stress Urinary Incontinence (SUI). After an increasing number of incidences about complications brought about by this procedure, the FDA declared safety information about the serious risks of TVM implantation.
The most frequently reported complication is mesh erosion, also called mesh extrusion, protrusion or exposure. This is when the mesh implanted vaginally protrudes from the vagina. Doctors diagnose this through vaginoscopy, the use of an endoscope to visualize the vaginal canal.
The common reasons for this include a surgical wound that has not fully recovered or a surgical mesh with an inferior quality. Based on some researches, this type of negative reaction mostly affects women whose estrogen levels are low.
Other predisposing factors to this complication include old age, smoking, past records of removal of the uterus, and, surgical mesh implants that don’t match the size of the vaginal wall.
Mesh erosion is introduced by primary signs. Most frequently, patients experience tightening in the vagina, and most commonly this is associated with dyspareunia and pain while sitting in the same position for a long time. As most commonly recorded, these signs start to appear at least 1 month after the TVM implantation. Bleeding and foul-smelling vaginal discharges are signs that could be more harmful because these can cause infection.
There are various approaches to handle mesh exposure with different degrees of erosion. For very small exposures, i.e. within 1cm range, the entire mesh need not be removed. Medical experts of TVM typically correct these erosions by trimming the exposed part of the mesh and tucking it in making the wounds restore on its own. On the other hand, if mesh erosion occurs during healing after the surgery, physicians usually start treating with antibiotics and vaginal estrogen cream. |But if mesh erosion happens some time after while the surgical wound is healing, doctors usually prescribe antibiotic and vaginal estrogen cream treatment. |However, when mesh erosions develop while the tissues of the surgical wound are still in the recovery stage, doctors then use antibiotic and vaginal estrogen cream as medical care.} If the exposed mesh is still not healed after 2 or 4 weeks, surgeons will proceed with the excision of the exposed mesh.
In extensive exposures like when it is the whole surgical mesh exposed through the vagina, the whole surgical mesh is excised. Physicians would then be inclined to recommend a new procedure to treat POP and SUI.
Mesh erosions need to be managed closely, as it is very possible for this complication to recur. Patients who have developed a mesh erosion complication mostly had to tolerate more corrective procedures that are insufferable. Nevertheless, this serious complication can be avoided. It is very important for patients to be cautious not to strain themselves during the recuperation stage and keep a monthly appointment with their respective doctors to check for possible signs of complications.
References:
http://blogs.webmd.com/womens-health/2011/08/vaginal-mesh-new-fda-warnings.html
http://www.icsoffice.org/Abstracts/Publish/105/000870.pdf
http://www.empowher.com/sexual-well-being/content/vaginal-mesh-erosion-part-2?page=0,2
The most frequently reported complication is mesh erosion, also called mesh extrusion, protrusion or exposure. This is when the mesh implanted vaginally protrudes from the vagina. Doctors diagnose this through vaginoscopy, the use of an endoscope to visualize the vaginal canal.
The common reasons for this include a surgical wound that has not fully recovered or a surgical mesh with an inferior quality. Based on some researches, this type of negative reaction mostly affects women whose estrogen levels are low.
Other predisposing factors to this complication include old age, smoking, past records of removal of the uterus, and, surgical mesh implants that don’t match the size of the vaginal wall.
Mesh erosion is introduced by primary signs. Most frequently, patients experience tightening in the vagina, and most commonly this is associated with dyspareunia and pain while sitting in the same position for a long time. As most commonly recorded, these signs start to appear at least 1 month after the TVM implantation. Bleeding and foul-smelling vaginal discharges are signs that could be more harmful because these can cause infection.
There are various approaches to handle mesh exposure with different degrees of erosion. For very small exposures, i.e. within 1cm range, the entire mesh need not be removed. Medical experts of TVM typically correct these erosions by trimming the exposed part of the mesh and tucking it in making the wounds restore on its own. On the other hand, if mesh erosion occurs during healing after the surgery, physicians usually start treating with antibiotics and vaginal estrogen cream. |But if mesh erosion happens some time after while the surgical wound is healing, doctors usually prescribe antibiotic and vaginal estrogen cream treatment. |However, when mesh erosions develop while the tissues of the surgical wound are still in the recovery stage, doctors then use antibiotic and vaginal estrogen cream as medical care.} If the exposed mesh is still not healed after 2 or 4 weeks, surgeons will proceed with the excision of the exposed mesh.
In extensive exposures like when it is the whole surgical mesh exposed through the vagina, the whole surgical mesh is excised. Physicians would then be inclined to recommend a new procedure to treat POP and SUI.
Mesh erosions need to be managed closely, as it is very possible for this complication to recur. Patients who have developed a mesh erosion complication mostly had to tolerate more corrective procedures that are insufferable. Nevertheless, this serious complication can be avoided. It is very important for patients to be cautious not to strain themselves during the recuperation stage and keep a monthly appointment with their respective doctors to check for possible signs of complications.
References:
http://blogs.webmd.com/womens-health/2011/08/vaginal-mesh-new-fda-warnings.html
http://www.icsoffice.org/Abstracts/Publish/105/000870.pdf
http://www.empowher.com/sexual-well-being/content/vaginal-mesh-erosion-part-2?page=0,2