The Use of Mesh in Recurrent Prolapse

Pelvic organ prolapse occurs when the pelvic floor soft tissue becomes weak or stretched and cannot hold the female pelvic organs such as bladder, uterus, rectum, vagina and bowel in place causing them to come down and bulge into the vagina. It commonly occurs from child birth and most women do not have any symptoms of the condition. About 2% of patient’s experience symptoms that interfere with their sexual, urinary, defecatory and other daily activities requiring treatment. Symptoms can usually be managed in most patients by performing pelvic floor exercises and using removable vaginal inserts called pessaries. In rare cases when the symptoms are unmanageable, surgery is advised and is optional. The surgical correction depends on the symptoms, their severity and the organ involved. Surgery may include removal of the uterus (hysterectomy) or repair of the supporting tissue of the involved organ. Surgery can be performed either through the abdomen (open or laparoscopic) or transvaginally. Traditional surgical treatment has a high recurrence rate where pelvic organ prolapse reoccurs after the surgery.

Pelvic prolapse can also be treated surgically by using mesh. The use of mesh increases the life of the prolapsed repair and reduces the risk of recurrence significantly. Most surgical meshes for urogynaecological procedures are made of non-absorbable synthetic polypropylene. They are placed in the anterior or posterior wall or top of the vagina depending on the organ that has prolapsed. After the surgery, the tissue grows through the holes in the mesh and the mesh becomes part of the wall where it is placed, providing additional support to the tissue.

General complications from prolapse repair surgery may include infection, bleeding, bladder infection, injury to urinary bladder, bowel or blood vessels and complications due to anaesthesia. Rarely, some women develop chronic vaginal pain and pain with intercourse after the surgery with or without the use of mesh and may require additional surgery.

Complications due to the implantation of the mesh may cause short term buttock or groin pain and constipation. In rare cases, exposure of the mesh may occur in the vaginal wall, leading to discomfort in intercourse and blood spotting and may require additional surgery.