Transvaginal mesh
The surgical mesh is placed transvaginally to reconstruct weakened pelvic muscle walls and to support the urethra or bladder.
[12] Transvaginal mesh is used to repair symptomatic pelvic organ prolapse that causes pain and discomfort among patients and to treat stress urinary incontinence.
[5] As pelvic organ prolapse and stress urinary incontinence can be present separately or simultaneously, surgical mesh is implanted into vesicovaginal and rectovaginal region through the vaginal route in different approaches, to manage patients’ condition properly.
[3] For cystocele corrections, horizontal arms will be inserted on the lateral bladder walls through the obturator foramen by an Emmet needle.
[5] Meanwhile, vertical straps will be placed onto the fibrous thickenings of pelvic fascia anteriorly and posteriorly in order to reposition the bladder.
[5] Alternatively, an incision on the posterior vaginal wall will be needed to place the mesh through the perineal skin for rectocele correction.
[5] After putting the prolapsed organs back to its original position and reinforcing the vaginal wall, the incision is closed with sutures.
[9] For absorbable meshes, longer recovery time and lower durability are expected as native tissues need to grow into the pores to support the weakened organs.
[14] The transvaginal mesh is then placed under the urethra through the retropubic space, which is anterior to bladder and posterior to pubic symphysis, and brought out to the suprapubic area.
[14] The transvaginal mesh is inserted through the obturator foramen to avoid damage of pelvic organs, and brought out to the skin in the groin area.
[3] Generally, it is the most common postoperative complication and 10.3% of the patients experience mesh erosion within 12 months for pelvic organ prolapse (POP) repair.
[3][4] Patients with this complication usually present with discomfort in the vagina as a result of mucosal irritation, abnormal vaginal discharge, or pelvic pain.
[4] As vaginal extrusion worsen due to delayed healing, conservative treatment with oestrogen or antibiotics and recommendation for sexual abstinence is usually suggested to alleviate the symptoms.
[3][4] One hypothesised aetiology for mesh-related pain is that inflammatory response induces the shrinkage of mesh, leading to vaginal tightening.
[4][24] Although postoperative infection seldom occur among patients who have undergone mesh surgery, it is still an inherent risk for any surgical implantations and results in severe implications.
[5] Initially used in the 50s to mend abdominal hernias, gynecologists started to use meshes to repair pelvic organ prolapse (POP) and stress urinary incontinence (SUI) in the 90s.
