If you are asking this question, you are probably considering treatment for urinary incontinence and you have probably found negative information on Google searches and other media sources describing vaginal slings, transvaginal mesh, and prolapse mesh. We understand that you may now feel afraid and confused. You are not alone. In fact, we discuss these topics daily in our office with patients suffering from urinary incontinence and other pelvic floor conditions. We feel that there are important differences between bladder or vaginal slings and transvaginal mesh for prolapse repairs. Hopefully, the information outlined below will help you to understand the differences, and help you to figure out what may be a safe and effective option for you.
Slings are considered by most urologists, urogynecologists and pelvic floor surgeons to be the gold standard treatment for stress urinary incontinence. This is usually the most common procedure performed by a urogynecologist, especially considering the high prevalence of female stress incontinence. The sling acts as a hammock around the urethra (the tube where our urine is released) and prevents it from opening during physical stresses on the bladder like a laugh, sneeze or cough. To place a sling, a small vaginal incision is made to access the urethra and the sling is then positioned under and around the urethra to support it in the closed position. The sling may be made of synthetic mesh, a woman’s own tissue, tissue from a cadaver, or animal tissue. Typically, we use synthetic material over human or animal tissue because we have found it to cause fewer side effects for patients. In addition, studies on synthetic material slings confirm high success rates around 90% and longevity of response. These procedures can commonly be performed at an ambulatory surgical center and patients typically heal rapidly.
Where does the controversy come from?
Following the widespread success of slings for incontinence, transvaginal mesh “kits” were introduced to surgeons to treat pelvic organ prolapse. This included a prolapsed, or “dropped” bladder, which is a related problem to urinary incontinence. These “kits” had a more rapid approval from the U.S. Food and Drug Administration (FDA) as they were felt to be similar to slings which were already widely and successfully being used. However, in 2011 after several years of use, the FDA issued a formal statement that transvaginal mesh may put women at a higher risk of complications without increased benefit to their quality of life. This sparked a large debate about the issue and led to advertisements seeking patients to file lawsuits. You may have seen some evidence of this on your Google search. The FDA spent a great deal of effort to review many products used in pelvic floor surgery. Ultimately, mesh products that were associated with increased risks of complications were pulled off the market. Products made out of mesh that were never taken off the market, that are currently approved by the FDA, and endorsed by the majority of urogynecologists include bladder slings for incontinence and mesh placed from an abdominal (or laparoscopic/robotic) approach to repair prolapse.
At the Florida Center for Urogynecology, we are not currently recommending any transvaginal kit mesh repairs for prolapse. We do, however, perform transvaginal mesh removal and repair. As outlined above, we do successfully and from a minimally invasive standpoint, perform slings for incontinence and use mesh to repair severe prolapse from a robotic approach. Importantly, and we feel certainly better than Googling, obtain advice from a board-certified urogynecologist who can provide expert care for your individual condition.