The controversy surrounding the vaginal mesh device appears to become more heated with the recent position statement issued by two medical groups associated with female pelvic medicine. The American Urogynecologic Society (AUGS) and Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) have publicly endorsed the use of midurethral sling procedures for the treatment of stress urinary incontinence (SUI) and have blamed the media and lawyers for the vaginal mesh controversy. Results of various studies and statements from a number of pelvic surgeons, notwithstanding the stand of these organizations, would still show that this specific sling device has been linked to severe complications.
The following are among the more common and severe complications linked to sling procedures using the midurethral sling devices:
De Novo Urge 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. The onset of urge urinary incontinence after a sling procedure characterizes de novo urgency. To be considered as a complication, this must persist six months after the surgery and must not have been present before undergoing the operation. Experiencing this adverse effect can be very tough for any woman who may have just wanted to rid of herself of SUI but instead ended up with another form of urinary incontinence.
Perforation of Pelvic Organs
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. While almost all pelvic organs may be exposed to this complicaton, the most common perforation is that of the bladder which has been recorded to happen in seven to ten percent of all cases. This may also affect the urethra and in rare cases, the bowels or the rectum. Aside from the great pain and discomfort, this complication has been regarded as one of the most lethal especially when urine or feces gets into the bloodstream that may result to severe infections.
Hemorrhage and Vascular Injury
This complication may not be as common as the others, but this has been recognized as the most feared side effect since any injury to the blood vessels may result to death. The most number of complications, among the different sling procedures, were those that used the midurethral method. 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
Just like the repairs for pelvic organ prolapse (POP) and the other types of sling procedures, mesh erosion has been found to be a very common complication after an SUI repair using the midurethral method. Mesh has been known to erode into the urethra and bladder causing the patient to experience symptoms such as pain during urination, dyspareunia or painful sexual intercourse, a feeling of burning sensation, and a host of urinary problems.
When the bowel and colon are the organs affected in the mesh erosion, symptoms such as severe pain, fever, infections, abscess, and even the deadly sepsis may develop. Experts have noted that this complication may appear months or even years after the procedure and cause symptoms such as abdominal bloating, constipation, and painful bowel movements.
References:
laborie.com
urology.ucsf.edu
medscape.org
meshsurgeons.com
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