Transvaginal Mesh (TVM) was a common option to correct women’s support issues until several years ago. It is still used to some extent. There are many problems or complications that may occur with vaginal mesh including but not limited to: mesh extrusion, exposure and erosion, infection, incomplete bladder emptying, painful defecation, frequency, urgency of urination, painful urination, chronic UTIs (bladder infections), pain with intercourse (dyspareunia), recurrent vaginal infections, and pelvic, abdominal, groin (inguinal), buttocks, and inner thigh pain. If these symptoms are persisting despite conservative treatment removing the mesh may be the best option. There can be no guarantee removing the mesh will take away your symptoms but if the symptoms are severe these safe and effective procedures should be considered.
Without surgery, persistent vaginal mesh problems cannot normally be fully treated. The type, duration, and symptoms associated with a mesh complication helps the patient and the experienced mesh surgeon determine the correct approach to symptoms resolution. Patients experiencing:
Mesh exposure: is defined as area of mesh without skin coverage which appears to be flat and not protruding above the level of the skin i.e., simply there is no vaginal skin over the mesh. Mesh exposure can be asymptomatic or create pain with or without intercourse and can often be treated with transvaginal estrogen. Often over time the vaginal skin will grow over and cover the mesh. If the skin does not cover over the mesh in approximately 12 weeks the exposed mesh may need to be surgically revised.
Mesh extrusion: is defined as exposed mesh that protrude or sticks out beyond the plane of the vaginal skin. Extrusion associated symptoms may include pain, painful intercourse (aka dyspareunia) to the patient and or her partner, a pinching or pricking sensation in the vagina and a course roughness to the to touch. Estrogen alone will not allow the skin to grow over the mesh as the mesh is protruding beyond the level of the skin. The best solution is to excise the mesh in this immediate area. Obviously if the mesh is protruding a few millimeters one can remove a minimal amount of mesh but if the mesh is extruding 2 – 3 cm (2.54 cm = 1 inch) then a much larger portion of the mesh needs to be removed. If the patient is experiencing pain all the time and not just with intercourse, then the whole mesh implant may need to be removed.
Mesh erosion: is defined as mesh which has displaced into a neighboring organ such as the urethra, rectum, bladder or intestines. The most common site of erosion are the bladder and urethra but can also be found in the rectum and the intestines. These patients can experience chronic or intermittent pain as well as pain with urination or defecation. Patients may also experience blood in the urine or feces. Some patients can have recurrent bladder infections if the mesh is in the urethra or bladder. Still other patients do not have any symptoms whatsoever. These patients are usually best managed surgically with complete mesh removal and repair of the damaged organ.
Mesh infection: is defined as persistent pus drainage or an abscess (pocket of pus) located in direct contact with the mesh implant. These patients usually present with vaginal, pelvic, rectal, buttocks or lower abdominal pain and are found to have an abscess and even a fever. Sometimes the infection can be treated with just antibiotics and others may requires antibiotics and surgery for mesh removal.
Incomplete bladder emptying/Urine retention: is often defined as the inability to expel at least 80% of the bladders content. Often doctors will have a post urination bladder residual as a cut off like 100 mL. In other words, if the patient voids but leaves more than 100 mL in the bladder after the urination (i.e., her urine residual) she is said to have incomplete bladder emptying.
This complication occurs in approximately 1-2 % of the time after a sling which has been placed for stress urine incontinence (SUI). Incomplete bladder emptying or urine retention can occur from placing the sling too tightly or if the mesh slings scars too tightly. This can create an obstructive effect at the urethra inhibiting the emptying of the bladder. If the patient has been diagnosed with retention or incomplete bladder emptying due to the sling it can be cut, partially removed or completely removed based upon the patient’s associated symptoms and clinical picture.
Dr. Guerette has the most experience with mesh removal and revision in the Mid-Atlantic. Complete removal can usually be accomplished with a small vaginal incision with a short, outpatient procedure. More complex mesh removal can be performed safely and successfully with a robotic approach. Many physicians and public information will indicate that removing vaginal mesh is impossible or very risky. In experienced hands this is not the case. There is no reason to continue to suffer from a mesh procedure that did not heal well and continues to cause issues. Let the IWI team and Dr. Guerette get you back to normal.
"I think the thing that stood out most about the office is that I really felt like, Dr. Guerette understood what I was talking about when I started talking about some of the bladder issues I had. And number two,everybody just seemed really very caring. I really appreciated that."
"I would recommend Dr. G and Jennifer because they are the best. They listen, they're very patient and they really know their stuff! I would like to add that since I have, found Dr. G and Jennifer, I have learned a lot about myself and what I'm going through, that I'm not the only one and there's help so don't have to suffer in silence any longer."
"When I was here, I felt completely heard. I felt, seen and understood. You guys really helped me. You made me not feel, you made me feel like a human. You didn't make me feel like I was a patient."
"I have a much better idea of what's going on with my body and the things that I need to do to, help be more comfortable, have a better quality of life."
