Mesh: That sounds bad, right?

I’m sure many readers have seen or heard the commercials featuring law firms that do not have many very nice things to say about “mesh”.

So what is mesh and what should I do about it?

“Mesh” often refers to a web-like sheet of a kind of plastic, polypropylene, that has been used medically for various reasons for many years. This mesh is woven into various shapes and sizes. It is used for large blood vessel reconstruction, hernia repair (umbilical, inguinal, ventral, etc.), incontinence and pelvic organ prolapse.

The controversy surrounding mesh focuses on mesh products that were placed vaginally for pelvic organ prolapse. Prolapse is a condition where the bladder, bowel, or uterus is literally falling out of the vagina, usually causing a prominent bulge. These prolapse-fixing products are often large sheets of oddly-shaped mesh meant to reinforce weakened vaginal tissues. If used properly, they helped many women with their prolapse problems. If used improperly and in the wrong patients, the mesh could erode into structures nearby such as the bladder, the ureter, vagina, or bowel. Usually this requries an additional surgical procedure to remove the mesh. This need for re-operation due to mesh complications led the the Food and Drug Administration (FDA) to issue a “Safety Communication” regarding vaginal mesh for pelvic organ prolapse.

Once again, the mesh “controversy” is regarding mesh used for pelvic organ prolapse. The small pieces of mesh desiged to treat female incontinence are not implicated as problematic and still remain an excellent option for treating stress incontinence. This is a type of incontinence that is often best treated with surgery as no medications are effective. Pelvic exercises (kegels) are often tried first but some women remain bothered by the incontinence and surgery is the next step.

Christopher Manakas, MD

About Christopher Manakas, MD

Education
Indiana University School of Medicine, Indianapolis

Residency
University of Wisconsin Hospital & Clinics
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