Risks associated with mesh pelvic floor repair

[Violet M]

Please comment if you have developed chronic pelvic pain from mesh pelvic floor repair surgery.

http://www.ncbi.nlm.nih.gov/pubmed/21592280

BJU Int. 2011 Jun;107(11):1704-19. doi: 10.1111/j.1464-410X.2011.10123.x.
Pelvic organ prolapse (POP) surgery: the evidence for the repairs.
Gomelsky A, Penson DF, Dmochowski RR.
Source
Department of Urology, Louisiana State University Health Sciences Center - Shreveport, LA and *Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Abstract
What is known on the subject? and What does the study add? Substantial experience of the outcomes has been gathered regarding the acute and sub-acute experience with various types of corrective procedures for POP. These include long-term POP correction as well as more recent recognition of improvement in functional disorders associated with POP such as UI, colorectal dysfunction, and sexual dysfunction. Long-term follow-up is available for some of the older types of interventions and current multicentre trials are being accrued with longer term follow-up for new interventions including mesh-type repairs. The study adds a condensed and summarized version of the current literature regarding the various interventions for POP and also provides an overview of the current controversies and areas where knowledge is incomplete and in need of further elaboration for definitive answers regarding optimization of surgical care for POP. • Our aim is to summarise the available data on the transvaginal placement of synthetic mesh for pelvic organ prolapse (POP) repair, with a focus on the outcomes and complications of commercial POP-repair kits. • As the stability and durability of autologous tissues may be questionable, nonabsorbable, synthetic materials are an attractive alternative for providing additional support during POP surgery. These materials are not novel, and most have been used for many years in surgical applications, e.g. hernia repairs. • While theoretically appealing, the implantation of synthetic mesh in the pelvis may be associated with inherent adverse consequences, such as erosion, extrusion, and infection. Additionally, the routine use of these materials may carry potential long-term complications, such as dyspareunia, chronic pelvic pain, and vaginal distortion. • The success and failure of mesh-augmented POP repair is related not only to the synthetic material itself, but also to patient- and surgeon-related factors. • Recent warnings by the USA Food and Drug Administration and other groups regarding adverse events further complicate the decision to use synthetic mesh.

[calluna]

That would be me.....

Well, what can I say. My complications were not even long-term, they were immediate. On waking from the anaesthetic I became aware that I had complete numbness in the left pudendal distribution; the feeling came back over 2-3 weeks, but it came back as pain. I still have a lot of numb areas, although it is hard to distinguish whether or not this is due to scar tissue, because there is plenty of that from previous ops.

They mention mesh extrusions. I have had one extrusion fixed twice already, it has come back yet again and I now have another one as well in a different place.

They also mention patient and surgeon -related factors. I was a high risk for post-op problems as I had had unfortunately had multiple previous gynae surgeries. My surgeon was a pelvic floor specialist, an innovator in the use of mesh, and very experienced.

I would not want to go back and be as I was before the surgery. Basically nothing south of the navel worked properly if it even worked at all. I would rather be coping with PN. And I was warned before the surgery that there was a risk of increased pain post op.

[nyt]

One of the problems with FDA approvals of meshes is that they assume the same type of material can be used in the vaginal/urethra area as that used in the abdomen or groins for hernias without worry of erosion. It turns out that some current research in rabbits suggest that this assumption was incorrect. There is still a lot unknown about the effects of estrogen on erosion rates ie do women without ovaries have a higher rate of erosions than women with ovaries, what are the effects of estrogen on erosion rates.

Another concern has been the mesh kits help standardize the protocol but sadly many physicians really aren't skilled enough to be doing these very complex surgeries to place them. I know Dr. Hibner has removed mesh from the pudendal nerve on a couple of women who have had them for prolapses. In my case the mesh was too close to the obturator nerve, didn't entrap it just too close.

Even though the mesh from the bladder sling I had changed my life for the worst and I would not wish this on my worst enemy I would still not want products for incontinence or prolapses removed from the market as there are too many individuals out that can benefit from them. The key is being told what all the complications could be and really educate individuals on all the pros and cons.

[HerMajesty]

I am revisiting this thread because I just found out my son has an inguinal hernia which will need repair. It was discovered due to a palpable mass in the testicle and confirmed through testicular ultrasound, so it must be rather low down in the inguinal canal. I remembered this thread and am wondering if I should decline a mesh repair and if so what the alternatives are...is mesh so commonplace that if I request another type I will get looked at like I have 3 heads and have to wage another medical battle??? I feel rather uninformed on the subject so unless I get more info, it will be difficult for me to make the safest choice for my child. Opinions anyone?

[calluna]

They've been using mesh for hernia repair in adults for ages. It is not the same deal as with pelvic floor repair, I don't think.

No personal experience, but my sister had an inguinal hernia repaired with mesh. She had a lot of problems with post-op infection. Once that was dealt with - which wasn't easy, and took repeated surgeries - she's had no further problems, either with the hernia or the mesh.

However, with a child, the approach may well be different. My sister also had an umbilical hernia repaired as a child, they did not use mesh for that and it was completely problem-free. I would wait and see what they say. You are already much more informed than most parents in this situation, I am sure!

[Karyn]

Hi HM,
I don't know jack about this topic, but I did want to offer my support to you and your son. My gosh - what a tough year for the poor little guy! Is the mesh repair the only thing his physician offered you as a treatment plan? Or have you even gotten that far, yet? Was the hernia picked up during a routine exam, or was he exhibiting symptoms prior to his doctors visit?
I'll be sure to pass on any info I can find about this. You're both in my thoughts.
Hugs,
Karyn

[nyt]

HerMajesty from all the reading I have done on mesh because of all the problems I had with my bladder sling there aren't the same problems when used in the abdominal wall. Interesting study done a few years ago in rabbits and there was erosion of the vaginal mesh implant but not abdominal. No one really is sure why but there is something very different about the vaginal wall that erosion is a problem. When the FDA approved meshes for bladder slings they used the argument that they are fine in hernia repairs unfortunately there are multiple of issues when used for bladder slings and are a nightmare if not placed to perfection. Now having said all of that I do not know if the surgical procedure for hernia repair on children is different from adults. Good luck and prayes are sent for all in your family.

[HerMajesty]

Thanks for reassuring an hysterical mommy gals - I did find an article comparing outcomes for mesh and nonmesh repairs, and the mesh repairs actually do have a lower complication / better outcome rate overall so I will stop freaking out. I absolutely panic at the idea that a kid of mine could be put at risk for pelvic pain.
Yes it has been a yucky year, for those that don't know what Karyn is talking about he had a sinus infection for a solid 2 - 3 months this winter, whereupon a CAT scan showed his sinuses (ALL of them) to be almost 100% occluded and he had surgery to ream out the sinuses and remove the adenoids. The sinus surgery worked great but after that he still had chronic fatigue; we discovered it was because all the steroids and antibiotics from his respiratory issues have left his gut over-colonized with yeast so he is on a probiotic / vitamin regimen now. So I thought the poor kid was finally all squared away, the hernia was a total surprise found at his annual check-up.
No news on the exact nature of the repair; the Pediatrician is referring him to a Pediatric Urologist. The radiology report states that the hernia is associated with a mass of fat & fluid in the testicle which is a Urologist thing, the Pediatrician obviously was a bit puzzled by the ultrasound report But I think mesh repair is pretty standard so I wanted to make sure there was no info about a better way just starting to emerge in medical practice - I want him to have the best.
LOL as to the "little guy" getting "pediatric surgery", my son is 13 years old, 6'1" tall, 170 pounds, and hairier than your average 40 year old. His statement about the testicular ultrasound was that he has now lost all his dignity

[nyt]

You have a BIG teenager at home. Can't imagine what your grocery bill is like. If you are smart you ship him out to friends houses for dinner a couple of nights a week to cut down on your food bill . Hope you told him you lost all your dignity when he came into the world so no sympathy from mom.

[HerMajesty]

Actually because I got interstitial cystitis at age 14 and began to have catheters rammed in me ad nauseum, I told him I lost my dignity around the same age he did...and since he's been out of diapers for 10 years, he got a full 10 years of dignity which should be enough for anyone
Yep, food bill is LARGE