Pelvic mesh related complications

A synthetic prosthesis that is manufactured into a net-like product to enhance pelvic floor repair for women with recurrent pelvic floor issues or advanced vaginal prolapse.

Surgical mesh has been used for the treatment of various conditions including:

Pelvic organ prolapse

• Abdominal mesh
  Introduced into the abdomen through laparoscopy, robotic approach or an open surgery. This option is usually reserved for advanced or recurrent pelvic organ prolapse.

• Vaginal mesh
  Inserted through a vagina incision (Vaginal mesh is no longer available in Australia as a treatment of pelvic organ prolapse due to its safety concerns)

Stress urinary incontinence

• Retropubic mid urethral sling
  A small piece of synthetic mesh sling that was inserted via small vagina incision with exit point just above the pubic bone

• Transobturator mid urethral sling
  A small piece of synthetic mesh sling that was inserted via small vagina incision with exit point close to your groin

Careful clinical assessment to rule out pelvic mesh complications or other potential causes that might be unrelated to the mesh.

The clinical assessment will be supplemented by questionnaires to assess your pelvic floor function, bladder and bowel symptoms, sexual function and impact of symptoms on overall quality of life.

A series of investigations that may include specialist imaging (pelvic ultrasound or MRI), urodynamics, examination under anaesthesia and cystoscopy or blood test if indicated.

Women who have pelvic mesh complications usually require multidisciplinary team input to optimise the pain control, improve their quality of life and assist women to achieve their activities of daily living. The role of each discipline is listed below:

Pelvic floor physiotherapy
Provide education on pelvic anatomy and function, assist in pelvic floor muscle down training & trigger points release for women who have long standing pelvic pain and painful intercourse

Pain team specialist
Working together with women with chronic pelvic pain to provide a individualised treatment plan. A wide range of analgesia options are available, and this can be offered after discussion with the pain specialist.

Clinical psychologist
Offers individualised patient-centred therapeutic approach including cognitive behaviour therapy, mindfulness, acceptance and commitment therapy

Urogynaecologist, Gynaecologist/Pelvic Floor Reconstruction Surgeon
Women who present with small vaginal mesh exposure can be managed conservatively with vaginal oestrogen therapy for several weeks. Women with large vaginal mesh exposure usually require surgical revision and vaginal oestrogen is unlikely to be successful.

Women who wish to consider surgical removal of mesh need to be assessed individually by the specialist. In certain circumstances, surgical intervention may not be appropriate.

Surgical removal can be considered after careful assessment. The options are:

1. Partial excision of mesh if only a small portion of mesh was exposed in the vagina

2. Complete removal can be considered if women had multiple mesh excisions, erosion into bladder, urethra or bowel, persistent pelvic pain failed to improve with conservative management

In some cases, surgical removal may not resolve all your symptoms. Some women may have worsening of pelvic pain, recurrence of urinary incontinence and pelvic organ prolapse after surgical removal of mesh.

Dr Yong offers native tissue reconstruction surgery to women with recurrent vaginal prolapse or urinary incontinence after pelvic mesh removal from treatment complications

Dr Yong is part of multidisciplinary Pelvic Pain Service at Frances Perry House, Parkville. Please contact our room for further information.

Australian Commission on Safety and Quality in Health Care (ACSQHC)
https://www.safetyandquality.gov.au/sites/default/files/migrated/Treatment-Options-Complications-Consumer-Info.pdf