Treatment of Mesh Complications after Prolapse and Incontinence Surgery (Overview)

What are mesh complications?

Mesh complications are unexpected consequences of mesh prolapse and incontinence surgery that result in new symptoms that were not present before the surgery. They include:

  1. difficulty urinating or inability to urinate at all (urinary retention)
  2. urinating too often and having to rush to the bathroom (overactive bladder or OAB)
  3. urinary incontinence
  4. pain (including pain during sex)
  5. vaginal discharge or bleeding
  6. bladder stones
  7. ureteral obstruction (blockage to the kidney)

What is mesh?

Mesh is a man-made plastic like material that is used in surgery It is usually composed of single strands of polypropylene that are arranged in a lattice similar to a spider web.

How common are mesh complications?

Serious complications occur in up to about 5% of operations, but minor complications are more common and may be seen in up to 20% or more.

Why is mesh used in incontinence and prolapse surgery?

It is used for three reasons. Firstly, in some patients their own tissue is too weak, so the mesh is used as a support like sewing a patch over the hole in clothes. Secondly, in uncomplicated cases, the incisions are much smaller and the recovery is quicker with mesh compared to non-mesh surgeries. Finally, incontinence and prolapse surgery requires a high degree of expertise which is difficult for the surgeon to master; mesh surgery is much easier for the surgeon to learn.

What causes mesh complications?

Are they different from ordinary surgical complications? There four reasons why mesh complications occur. Firstly is the mesh itself. It is a foreign substance and the body may react to it by trying to expel it or cause excessive inflammation or scarring. It is even possible, though unproven, that some people could be allergic to it. Secondly, it can erode into adjacent organs or the vagina. Thirdly, it can form the nidus for infection. Lastly, because mesh surgeries are performed through small incisions with long sharp instruments, it is possible to damage adjacent organs, blood vessels and nerves without the surgeon even knowing it.

How are the complications treated?

The first step is to do a thorough evaluation to be sure that the symptoms are due to the mesh and not something else like infection. Once it has been determined that the symptoms are due to the mesh, it is usually necessary to do surgery remove all or part of the mesh and then to repair the damage done by the mesh. When the problem is difficulty urinating, though, it may be possible to just cut the mesh without removing it.

As a general rule, all of the corrective surgery can be done through the vagina without the need for an abdominal incision. Occasionally, though, abdominal surgery is necessary. Most of the time it can be accomplished with minimally invasive laparoscopic or robotic techniques, but sometimes an abdominal incision is necessary.

What are the results?

The results depends on many factors including the nature of the complication, how long it?s been since the original mesh surgery and the particulars of your overall health and anatomy. For patients with small erosions of mesh into the vagina, topical hormones or minor outpatient vaginal surgery is usually all that is necessary. For those with difficulty urinating or inability to urinate at all after sling surgery, the success rate is very high after surgery designed to cut or remove part of the sling. Surgery to repair a damaged ureter is also very successful. However, the success rate for all of the other kinds of complications is not as good and may require more than one operation.

If you cut or remove part of a sling, won?t the incontinence come back. While that is possible, fortunately, in most cases the incontinence either does not recur or is so mild that further surgery is not necessary.