Saturday, May 12, 2012

Transvaginal Mesh: Problems and Solutions

What is Pelvic Organ Prolapse?

When one or more of the pelvic organs shift downward, possibly even intruding into the vaginal canal, it is known as pelvic organ prolapse. The uterus, vagina, urethra, bladder or rectum can all drop from their proper position, causing a multitude of problems and issues. In the United States alone as many as one-quarter of all women have some level of pelvic organ prolapse. Surgeries performed to correct POP cost over a billion dollars annually with over 200,000 POP surgeries being performed each year. It is believed that pelvic organ prolapse will become an even more common female problem due to the aging of the Baby Boomers. Almost twenty percent of American women will undergo surgery for pelvic organ prolapse or stress urinary incontinence by the time they reach the age of 80, and of those, thirty percent will require additional surgeries.

Symptoms of Pelvic Organ Prolapse

Some women have few, if any symptoms related to their pelvic organ prolapse but the majority will suffer incontinence and will experience a feeling of pressure in the pelvic region. Others will suffer painful intercourse, chronic pelvic pain, pain in the lower back and constipation. Pregnancy is one of the primary risk factors for pelvic organ prolapse, especially those which involved a vaginal birth or forceps-assisted birth. Additional risk factors include a genetic predisposition, aging, being overweight or obese, estrogen deficiency from menopause, disorders of the connective tissues, previous pelvic surgeries or continuous abdominal pressure from strenuous coughing, vigorous physical activity or chronic constipation. Women who have had more than two children via vaginal birth will have a significantly increased risk of pelvic organ prolapse.

Lifestyle Treatments for Pelvic Organ Prolapse

Women with pelvic organ prolapse may want to try changing certain aspects of their lifestyle prior to considering surgical options. Exercises to strengthen the pelvic floor, devices which support the pelvic organs, medications to help tighten the muscles, estrogen injections, losing weight, quitting smoking and biofeedback are all possible options for pelvic organ prolapse.

What Surgical Options are Available to Repair POP?

Hysterectomies are still commonly performed in women with pelvic organ prolapse although there are a number of other surgical procedures available. The age and physical condition of the woman as well as the specific type of prolapse will have bearing on which procedure your doctor recommends. Surgeries may be performed through an abdominal incision or vaginally, however the goal is the same—to reposition the prolapsed organs, securing them to surrounding tissues.

Most often synthetic mesh is used to hold the organs in place although in some cases the woman’s own tissues are used to anchor the organs into their proper position. The ultimate goal of the surgical procedure is to put the organs back into place and to reinforce the weakened pelvic floor. There are three primary tissue repair materials—the first is synthetic mesh is made from polypropylene, and while this type of mesh is the most commonly used, there have been problems reported such as erosion and infection. Biologic grafts come from humans or animals and can be treated with chemicals to make the material more durable, however this treatment can make the graft almost like leather, causing it to become stiff and calcified and to sometimes require removal. The third type of tissue repair material is known as Surgisis Biodesign, and although it comes from an animal source it combines natures healing mechanisms with technology to encourage the body’s repair process.

What Types of Kits are Available for Repair of POP?

Pelvic organ prolapse repair kits are designed to treat pelvic organ prolapse in the most minimally invasive manner. These kits can be used in all types of repairs including apical, anterior and posterior. The pelvic organ prolapse kits contain pre-cut mesh, introducers and needles which anchor the mesh into the pelvic wall. The kits also contain synthetic or biosynthetic grafts which will attach to the pelvic wall in four different places with a goal or restoring the proper position of the pelvic organs, eliminating the worst symptoms of pelvic organ prolapse. American Medical Systems manufactures the Apogee and Perigee POP repair kits with implant materials of polypropylene or porcine dermis. Gynecare offers the Prolift repair system using polypropylene mesh and C.R. Bard uses polypropylene or porcine collagen in their Avaulta-Plus kit.

What is the Difference in a Vaginal Mesh Implant and a Vaginal Mesh System?

Although there are several manufacturers of vaginal mesh systems, they are substantially alike. The vaginal mesh system is essentially an intra-vaginal approach to apical and anterior pelvic organ prolapse, utilizing a fairly small incision and using mesh only where needed in order to reduce erosion risk. The vaginal mesh systems are designed to provide both Level I support at the apex of the vagina and Level II support in any area where a cystocele could likely occur. Anterior vaginal mesh systems are designed to help improve vaginal depth, and most of these systems are meant to leave at least 2 cm of undisturbed tissue at the apex of the vagina in order to further reduce the risk of erosion. The mesh leg assembly of the vaginal mesh system allows physicians to throw and place the assembly in one step while providing superior adjustability to provide more precise control of the placement of the mesh.

The vaginal mesh implant generally uses a larger piece of mesh in order to repair weakened or damaged tissue. The mesh can be made from either polypropylene or biosynthetic mesh. An incision will be made inside the vagina, and the tissues which support the vagina will be strengthened with stitches. The cut mesh will be placed under the vaginal skin to provide reinforcement. The mesh has many holes which allow the body’s tissues to grow into the mesh, holding it in place. The vaginal mesh implant is like a small hammock, and is considered a medical device due to the fact they are placed inside the body under anesthesia. While vaginal mesh implants are considered permanent, the number of women who have suffered additional problems from these mesh devices have dictated further surgeries to either remove or replace the mesh implant.

Author: Sullo & Sullo Attorneys

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