A PATIENT, 67, had a transvaginal repair with synthetic mesh for pelvic
prolapse. Four weeks later, she reported spotting, discomfort, and
irritation. The surgeon found that the surgical mesh had eroded into her
and prescribed estrogen cream for a month, but it wasn’t effective. The
needed more surgery for resection of the exposed mesh and closure of
Pelvic organ prolapse and stress urinary
incontinence are pelvic disorders affecting millions of women in the
They occur when pelvic floor muscles lose
strength, allowing pelvic organs, including the bladder and uterus, to
from their normal location and bulge through the vaginal wall (pelvic
prolapse), or diminishing bladder control (stress urinary incontinence).1,2
Treatment options for pelvic organ prolapse or
stress urinary incontinence include several surgical and nonsurgical
Transvaginal placement of mesh has become increasingly popular in recent
What’s the problem?
In the last 3 years, the FDA has received over 1,000
adverse event reports about mesh used in transvaginal surgical repair of
organ prolapse and stress urinary incontinence. These reports include
such as pain, infection, mesh erosion (into vagina, bowel, and bladder),
recurrence of prolapse or incontinence. Some reports involved rare but
intraoperative injuries such as bowel, bladder, or blood vessel
Most patients described in the adverse event reports needed medical or
intervention, and some required hospitalization.4
Although the exact cause of these adverse events hasn’t been identified,
they’re likely to be the result of multiple factors. Further
What precautions can you take?
Although treatment with mesh may have helped many
women, in others it’s caused complications affecting quality of life.3,4
A literature review
demonstrates conflicting information on success rates for transvaginal
placement, but everyone agrees on the need for controlled trials.5
If you care for a patient undergoing a transvaginal
mesh placement procedure, consider this advice:
- Become familiar with the types of mesh and procedures used for the
pelvic organ prolapse and treatment of stress urinary incontinence.
- Ensure that your patient has given her informed consent. Make sure
received appropriate information about her choice of treatment, the
procedure she’s undergoing, and possible adverse events.
- During preoperative teaching sessions, tell your patient about
adverse reactions, the signs and symptoms of infection, and when to
- If you’re an OR nurse, follow your facility’s policies and
recording information about implanted materials. Record the name of the
used and its catalog number, lot number, and size in the patient’s
- Provide your patient with a written copy of the patient labeling
surgical mesh manufacturer, if it’s available.
- If your patient has surgery to remove mesh, follow your facility’s
and procedures for properly handling the explanted mesh. Additionally,
your facility’s policies and procedures for reporting adverse events.