If you watch TV you may have seen commercials about lawsuits regarding vaginal mesh. What is the mesh controversy? The term “mesh” refers to a synthetic product used in surgical procedures. These can be made from various materials but the most commonly used mesh material in gynecology is polypropylene which is permanent and can be woven into sheets of various dimensions.
Polypropylene slings were introduced in the 1990’s to treat urinary stress incontinence with a minimally invasive approach. The success of the TVT Sling has resulted in it to becoming the minimally invasive procedure of choice for treating urinary stress incontinence. Medical device companies then took the technology of the TVT sling and applied it to treating pelvic organ prolapse in women with a minimally invasive approach. Transvaginal Mesh Kits were introduced in the early 2000’s with the theory being that it would be as effective for conditions like cystocele (bladder prolapse), rectocele (rectal bulging) and uterine prolapse as the sling was for Urinary Incontinence. The FDA approved the TVM products based on the fact that the TVT Sling had been so effective for urinary incontinence. Unfortunately, with time it was recognized the TVM procedures resulted in complications that could be quite debilitating to the patient. However, it should be noted that in experienced hands these complications may be reduced. Thus, in 2011 the FDA sent out a communication warning patients and physicians about the complications that were reported associated with the TVM devices. The lawsuits and commercials soon followed. Several points are worthy of note. The FDA did not recall any devices and the material of the mesh is not considered dangerous. Mesh used for slings for urinary stress incontinence and mesh used for laparoscopic procedures for pelvic organ prolapse was not part of the FDA communication and is considered safe and effective. The use of TVM can be an effective treatment for pelvic organ prolapse in experienced hands.