Pelvic mesh update

For the past years, there were increasing concerns about synthetic mesh use in pelvic floor reconstruction surgery. The issues started with negative publicities and litigations surrounding vaginal mesh use in prolapse surgery. Consequently, Australian Therapeutic Goods Administration (TGA) decided to remove transvaginal mesh products for treatment of pelvic organ prolapse and single incision mini slings for treatment of stress urinary incontinence in November 2017.

This outcome has understandably impacted women’s perceptions and decisions on mesh use in pelvic floor reconstruction surgery. Although synthetic mesh been viewed as a problematic treatment, but not many fully understood the types of mesh use for various indications.

What is mesh used for ?

Abdominal mesh has been utilized for abdominal hernia repair by general surgeon. From urogynaecology perspective, transvaginal or transabdominal mesh were used for treatment of pelvic organ prolapse. Synthetic midurethral sling on the other hand is introduced through a small incision vaginally to treat stress urinary incontinence but commonly misunderstood as transvaginal mesh due to the surgical route. Transvaginal mesh and mini slings have been withdrawn from the market but midurethral sling remain available as a treatment option.

Following the Senate Inquiry and mesh class action, most commercial companies decided to discontinue abdominal mesh supply or revised their indications of use in pelvic floor reconstruction. We believe these actions were taken to avoid further mesh lawsuit, not because of product defects.

So what is currently available?

With limited abdominal sacrocolpopexy mesh and increasing number of women declining mesh use, the utilization of synthetic mesh in female pelvic floor reconstruction surgery will eventually become obsolete regardless of the evidence of success. Under current climate, native tissue or mesh-free surgery is the preferred option over synthetic mesh. Burch colposuspension, the previous gold standard treatment for stress urinary incontinence prior to retropubic sling introduction is becoming the “new kid on the block”. Autologous fascia lata has been utilized for treatment of pelvic organ prolapse and stress urinary incontinence. This strong and versatile graft can be used either transabdominal or transvaginally. Although the clinical evidence remains sparse, fascia lata is a reasonable substitute for pelvic mesh and to be performed under clinical research setting while obtaining long term efficacy and safety data.  

 Our clinic offers mesh-free surgery options for treatment of pelvic organ prolapse and stress urinary incontinence. Dr Chin Yong will be able to provide more specific advice and the appropriateness of each option for you before deciding for surgery.