The vaginal mesh controversy appears to become more heated with the release by two medical groups associated with female pelvic medicine of a position statement. According to the American Urogynecologic Society (AUGS) and Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU), vaginal mesh devices, in particular the midurethral slings, are safe and effective for the repair of stress urinary incontinence (SUI). Results of various studies and statements from several pelvic surgeons, notwithstanding the view of these organizations, would still show that this specific sling device has been linked to severe complications.
Considered as among the more common and severe complications linked to midurethral sling procedures are the following:
De Novo Incontinence
A high incidence rate of de novo incontinence after a midurethral procedure, reported at 26 percent, has been experienced by patients according to results of several studies. When urge urinary incontinence appears after a sling procedure, the complication of de novo urgency is said to have occurred. This condition must persist six months after the surgery and must not have been present before the surgery in order to be considered a complication. For a woman who may have just wanted to rid herself of SUI and has instead ended up with another form of urinary incontinence can be very tough and frustrating.
Organ Perforation
When parts of the mesh, particularly the rough edges, puncture the nearby pelvic organs causing damages, a patient may be considered as experiencing organ perforation. The most common perforation is one that involves the bladder which has been recorded to happen in seven to ten percent of all cases, although almost all pelvic organs may be exposed to this complication. The urethra may also be commonly affected and in a limited number, the bowels or the rectum. The complication, which may cause great pain and discomfort, has also been regarded as one of the most lethal especially when urine or feces gets into the bloodstream that may trigger life-threatening infections.
Hemorrhage and Vascular Injury
With the possibility of death very high, this complication, which may involve injury to the blood vessel, has been recognized as the most feared adverse effect, although incidence may not be as high compared to others. Those that used the midurethral method reported the most number of complications among the different types of sling procedures. It was shown in one study that five percent of patients who underwent this type of sling procedure experienced blood loss of over 250 ml.
Erosion of Mesh
Mesh erosion has been found to be a very common complication after a SUI surgery using the midurethral method, just like the repairs for pelvic organ prolapse (POP) and other types of sling procedures. When mesh erodes into the bladder and urethra, a patient may experience dyspareunia or painful sexual intercourse, painful urination, a feeling of burning sensation, and various urinary problems.
Severe symptoms such as intense pain, fever, infections, abscess, and even the deadly sepsis may be encountered when mesh erosion occurs in the bowel and colon. This complication has been noted by medical experts to possibly arise months or even years after the surgery and may have symptoms such as painful bowel movement, pain, constipation, and abdominal bloating.
References:
laborie.com
urology.ucsf.edu
medscape.org
meshsurgeons.com
