Dr. Kay Hoskey Explains the FDA's New Guidelines for Mesh Procedures for Treating Prolapse
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Dr. Kay Hoskey, urogynecologist at AAMC Women's Center for Pelvic Health, describes different types of mesh and procedures used to treat pelvic organ prolapse. She also provides clarity about a recently released FDA document about complications with these procedures.
Recently, the FDA (Food and Drug Administration) reviewed some vaginal mesh procedures that are use to treat pelvic organ prolapse. What is prolapse? It's bulging or sagging of the pelvic organs, including the vaginal and/or uterus. it can be caused by abnormalities in the structure of the pelvic floor. The pelvic floor usually forms a support system for all the organs in the pelvis. When there's a weakness in the pelvic floor or the supporting muscles, surgery is often needed to treat the condition.
After reviewing the procedures, the FDA made some recommendations to healthcare professionals and the public. The procedures often use a mesh, which is inserted to provide extra support to structures in the pelvis. There are three (3) types of mesh procedures. The first is called a "sling." About the width of a piece of gum, mesh is placed under the urethra to provide support and prevent urine leakage. The second type, vaginal support, is a procedure where the vagina is placed back in its normal position and supported with mesh around it to keep it supported in the body. The third type of procedure involves vaginal insertion, where mesh is inserted through an incision in the vagina to provide support.
The FDA did not have any concerns or comments about the first two procedures, but they did want to alert the public that they have received an increased number of reports of complications with the vaginal insertion technique. the problems include mesh exposure, where the mesh is protruding through the vaginal incision, mesh erosion, where the mesh rubs through the surrounding organs or tissues, bleeding and pain, including pain during intercourse.
When a new patient is seen at the Women's Center for Pelvic Health, an extensive history is taken, a full examination is done and all patients are asked if they are experiencing any troublesome symptoms. Many issues can be addressed non-surgically, but if surgery is necessary mesh is not always used.
If you're considering prolapse surgery, make sure to follow these guidelines:
- Discuss all non-surgical options with your surgeon or physician.
- Mesh procedures may involve repeat surgeries to correct complications that may occur after the initial procedure and many times, these complications cannot be completely addressed through additional surgeries.
- Be aware of all risks associated with mesh or graft procedures.
If you continue to have vaginal discharge, vaginal bleeding, vaginal pain, groin pain or pain during intercourse, consult your physician or surgeon.