The FDA has issued warnings regarding placement of synthetic mesh transvaginally due to the higher rate of complications associated with this technique. While initial studies suggested a superior cure rate over traditional repairs, subsequent data demonstrated that the failure rate over time of vaginal repairs with and without mesh was similar but the mesh complication rates were unacceptably high. Dr. Kiley has always used the patient’s own tissue or, when necessary, a biologic graft material to perform transvaginal repairs.
With the widespread popularity of vaginal mesh kits, many women have undergone transvaginal prolapse repairs involving mesh placement as part of the repair. A mesh-specific complication rate of approximately 18 percent has led to a number of women needing mesh removal or revision. Symptoms of mesh complications may include pain or painful intercourse (for either partner), bleeding, discharge, or recurrent prolapse. Dr. Kiley has performed a number of these removal procedures and will take the time necessary to evaluate and properly treat the problem. Contact us today for a consultation if you are concerned about your symptoms.
NOTE: The FDA’s warning does not apply to the placement of mesh through the abdomen. Placement of synthetic mesh through the abdomen to repair hernias has been considered the gold standard for repairing them for many years. Likewise, mesh placed through the abdomen to repair pelvic prolapse is considered the “gold standard” as well. The incidence of mesh complications for the abdominal route (open, laparoscopic, or robotic) has been shown to be much lower than with the vaginal route. Although complications can occur with this technique, the low incidence of mesh related complications coupled with the superior outcome and lower failure rate has made this the repair of choice for many women. Similarly, a specific procedure for stress incontinence involving a small mesh tape placed transvaginally under the urethra is a current “gold standard” worldwide for treatment of stress incontinence. While it is not appropriate for every situation, it may be a good choice for some women. It is important to discuss this with your surgeon.
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