Vaginal mesh implants, sometimes known as sling implants, refer to the surgical devices used in providing medical treatment to cases of female urinary incontinence and pelvic organ prolapsed. These implants are usually made from a type of plastic material known as synthetic polypropylene. The treatment is intended for repairing weakened or damaged tissue in the vagina wall.
Other fabrics used in making mesh implants include human tissue, polyester and absorbable synthetic materials. They are designed to provide support to the vaginal wall and internal organs.
The Evolution of the Concept
Vaginal mesh has evolved over the past 50 years from surgical mesh that was first used for abdominal hernias to the soft polypropylene mesh that is used today. Originally, it was approved by the FDA for stress urinary incontinence in 1996. Later in 2002, the first mesh kits were approved for the treatment of pelvic organ prolapsed.
Vaginal mesh that have been used in the past came in varying types and differed in certain factors such as pore size, filament type and material type. Now, it has been established that one of the most important physical properties of a mesh is to have a large pore size. This is because a large pore size allows macrophages, which are important for the immune system, to enter the mesh and decrease the chance of infection and allow tissue ingrowth.
Reasons For Using These Implants
The mesh implants are created to help women who are suffering from stress urinary incontinence (SUI) and pelvic organ prolapsed (POP). Doctors would place the mesh through the abdomen or vagina in a surgical procedure. It is believed that this system of inserting the mesh through the woman’s privates is easier, quicker and less invasive.
Majority of women who would receive mesh implants as a medical treatment are more than the age of 50. This is because weak ligaments or connective tissue around the pelvic organs can be generally restored among younger women by performing pelvic floor exercises and doing changes in their lifestyle.
Usually, vaginal mesh implants are applicable to women who have gone through multiple childbirths. However, it can also happen to someone who’s had only one child but is probably overweight, has suffered from a tear and has never performed any exercises while being pregnant or after giving birth.
5 Types Of Mesh Implants
There are several types of mesh implants which all differ from the other depending on their purposes and how they are inserted.
1. Ventral mesh rectopexy
This type of implant is designed to release the rectum from the back of the bladder or vagina. It is usually fitted to the back part of the rectum in order to avoid prolapse.
2. TOT sling
This implant involves creating a “hammock” in the urethra that is made of fibrous tissue. Surgeons normally claim this type allows them to have the most control while performing the implant.
3. TVTO sling
Designed to prevent the perforation of the bladder, the TVTO sling is used by inserting it through the groin and then allowing it to sit under the urethra.
4. TVT sling
This type of sling is usually held in place by the body of the patient. The procedure involves inserting the sling with a plastic tape by making a cut in the vagina as well as a pair of incisions in the abdomen. It is placed to sit beneath the urethra.
This type of implant is embedded using a metallic inserter. It is placed close to the mid-section of the urethra. Using an inserter is believed to lower the risk of accidental cutting while doing the procedure.
How Vaginal Mesh Implants Are Used For Treating Pelvic Floor Disorders:
Vaginal mesh implants, otherwise known as surgical or transvaginal mesh, are used for treating pelvic-floor issues among women. They are used to treat:
1. Stress urinary incontinence (SUI)
This condition among women is present when there is the unintentional loss of urine brought by an activity or a physical movement such as running, sneezing, coughing or heavy lifting which bring pressure or stress on the bladder. To relieve such pressure, a surgical mesh is implanted through the woman’s privates in order to provide support to the bladder neck or urethra. This procedure is known as mesh sling or midurethral sling procedure.
A woman’s lifetime risk of developing stress urinary incontinence is around 20 to 40 percent.
2. Pelvic organ prolapsed (POP)
Pelvic organs in women have the tendency to prolapse or slip out of place as a result of losing support from weakened muscles and ligaments. In order to treat this condition, surgical mesh is implanted to provide reinforcement to the weakened wall. The procedure can be performed through the vagina (transvaginal) or the abdomen (transabdominal).
A woman’s lifetime risk of developing a prolapse in the pelvic organ is about 30 to 50 percent.
7 Benefits of Vaginal Mesh:
The following are some of the perceived benefits of vaginal mesh:
- It is non-immunogenic.
- It is non-carcinogenic.
- It is easily available.
- It is mechanically strong.
- It is pliable.
- It is resistant to infection and shrinkage.
- It avoids invasive graft harvest for quicker surgery and recovery.
Different Complications Involving Vaginal Mesh:
Just like any other surgical procedures, a vaginal mesh implant has certain risks and complications. The most common ones are infections and extrusions. Other complications that have been recorded include:
- erosion to the urethra and bladder
- urinary retention
- sexual dysfunction which can go from very severe to mild
- GI – bowel injury
- UTI, fever
- new onset of urinary frequency or urgency
- immunologic reactions to mesh
Alternative Surgical Options In Place Of Vaginal Mesh Implant Procedure:
There are a number of alternative surgical options to mesh repair. For treating stress incontinence, some of the options include injectible therapy, bladder neck suspensions, and autologous fascia slings. For the treatment of POP, certain options such as robotic sacrocolpopexy, abdominal sacrocolpopexy and anterior colporraphy can be employed.