Mesh

Mesh in vaginal prolapse surgery

Vaginal prolapse is a common condition where the bladder, uterus and or bowel protrudes into the vagina. This can cause symptoms such as a vaginal lump, constipation, difficulty emptying the bowel or bladder or problems with sexual intercourse. Treatment is only indicated when the prolapse is symptomatic. The majority of women will have improvement of symptoms following an operation.

Treatment options

Vaginal pessary

Some women will be suitable to try a vaginal pessary instead of surgery. Vaginal pessaries are a device, which supports the vagina, which need to be changed every 3 to 6 months. Vaginal pessaries have been proven to be successful as surgery in relieving prolapse symptoms in these women.

See: Vaginal pessary for prolapse.

Surgery

Depending on the severity of your symptoms and the type of prolapse your doctor may suggest you have surgery. The aim of surgery is to provide support for your vagina or uterus. Previous experience has shown that about 70% women undergoing conventional vaginal prolapse surgery have a successful outcome. Mesh reinforcement is used with the aim of reducing the risk of recurrence of the prolapse. It may provide a longer lasting repair and has been shown to be successful in 80% of people. The use of surgical mesh to reinforce prolapse repair is not new.

What is mesh?

•Mesh is a synthetic material and is permanent.
•Mesh has been extensively used in surgery, especially in hernia repairs.
•The mesh has many holes within it to allow the body's own tissue to grow into the mesh. The mesh then provides a framework of support.

What happens during surgery?

•Women undergoing a vaginal prolapse surgery can have the operation with regional (spinal) anaesthetic or general anaesthetic.
•There will be incisions made inside the vagina and the tissue supporting the vagina will be strengthened with stitches. This may be at the front or the back walls of the vagina or both, depending on the type of prolapse you have.
•The mesh is then placed underneath the vaginal skin. The body's own tissues will grow into the mesh within 3-4 weeks. The mesh provides reinforcement of the weakened vaginal tissue.
•The incision inside the vagina is then closed with stitches that will dissolve in one to two weeks.
•At the end of the operation a catheter will be inserted into the bladder to drain urine and a material pack will be placed in the vagina to prevent bleeding. These will remain in place for one to two days.
•Antibiotics will be given during the surgery, and you will be asked to take antibiotic tablets after the surgery.
•If you still have your womb (uterus), your doctor may suggest that you need a hysterectomy at the same time of your prolapse repair, this will be uncommon and because of, for example:
•period problems,
•pressure effects on the bladder or rectum

Are there any complications?

•Possible complications and discomforts from vaginal surgery for prolapse include pain, infection, recurrence of symptoms and/or prolapse, and pain with intercourse.
•Very rarely perforation of the rectum or bladder may occur.
•Whenever mesh is used, there is a small risk (about six percent or six in one hundred) of a tiny potion of the mesh becoming exposed in the vagina. This is usually treated with oestrogen if the vaginal skin is thin or a small vaginal operation to cover the mesh.
•There may be a slightly higher risk of infection with the use of mesh and all women will be given antibiotics during the operation.
•There are risks with having an operation, including the risks associated with anaesthetic; there is a risk of bleeding and the possibility of needing a blood transfusion. You are also at risk of infection within the pelvis or wound as well as clots in the legs that can travel to the lungs.