According to the Centers for Disease Control and Prevention, 20 million U.S. women have had a hysterectomy — the removal of the uterus — and another 600,000 women undergo the procedure every year. It is the second most common major surgical procedure in women of reproductive age, surpassed only by cesarean section. Some hysterectomies are performed to correct pelvic organ prolapse, which occurs when weak pelvic floor muscles allow one or more organs to drop into the vagina. However, women who have had hysterectomies are also at an increased risk of recurring pelvic organ prolapse, particularly if the hysterectomy was performed due to uterine prolapse.
When a hysterectomy is performed to repair prolapse, doctors may choose to insert a medical device known as transvaginal mesh to secure the pelvic organs and reinforce pelvic floor tissues. In 2010, more than 300,000 prolapse repair surgeries were performed, and 75,000 of those procedures used transvaginal mesh implants — which have proven problematic for many women.
Types of Hysterectomies
A hysterectomy is major surgery in which a woman’s uterus is removed. Other organs may also be removed — including the ovaries, fallopian tubes and cervix — depending upon the type of hysterectomy performed and the problems that are meant to be addressed by the procedure. Types of procedures include subtotal, total and radical hysterectomy.
Subtotal hysterectomy is performed through the abdomen and removes just the upper portion of the uterus, leaving the cervix intact. The fallopian tubes and ovaries may or may not be removed depending upon the condition being treated.
Total hysterectomy removes the uterus and the cervix, and can sometimes be performed through the vagina. Depending upon the circumstances, the fallopian tubes and ovaries may also be removed, but are often left intact. Vaginal hysterectomies are less invasive than abdominal procedures and typically involve less scarring, fewer complications and a shorter recovery period. Complicating factors, such as large fibroid tumors, can make abdominal hysterectomy necessary, since removal of the uterus through the vagina in such cases can be difficult.
A radical hysterectomy is generally performed only in cases of serious disease, such as cancer. These procedures typically remove the uterus, cervix, fallopian tubes, ovaries and pelvic lymph nodes and are performed through the abdomen.
When is a Hysterectomy Necessary?
Hysterectomy can be a medical necessity under some circumstances. These can include invasive cancer of the uterus, cervix or ovaries; chronic infections; uterine hemorrhaging; and serious complications during childbirth, such as a ruptured uterus.
Hysterectomy can also be an option in the treatment of a number of conditions, typically when symptoms cause severe pain or discomfort and less invasive treatments have failed to provide relief.
|These conditions can include:|
|Fibroids||These non-cancerous tumors develop in the uterus. They are not life-threatening, but can cause severe pain, cramping, bleeding and discomfort.|
|Endometriosis||With this condition, the tissue that lines the uterus spreads to other areas, such as the fallopian tubes, ovaries or other pelvic organs. Endometriosis can cause chronic back and pelvic pain, severe menstrual pain, irregular bleeding, and pain during or after sex.|
|Adenomyosis||This condition occurs when tissue that normally lines the uterus grows within the uterine walls, causing them to thicken. Symptoms can include heavy or long-term menstrual bleeding, pain during menstruation that worsens over time, and pelvic pain during sex.|
|Uterine Prolapse||This is often treated with hysterectomy in cases where there is severe pelvic pain and pressure, or when the organ emerges from the body through the vaginal canal.|
Mesh after a Hysterectomy
Surgical mesh is often inserted after hysterectomy to correct or prevent vaginal vault prolapse, which occurs when the top of the vagina collapses upon itself. Vaginal vault prolapse can occur more easily after hysterectomy, since the support once provided by the uterus is gone. Mesh is sutured to the top of the vagina, then to the connective tissues around the sacral bone to hold the vagina in place. Mesh may also be used to reinforce a weakened pelvic floor in cases where pelvic organs have prolapsed or prolapse appears likely to occur after the uterus is removed.
Traditionally, surgical mesh used to reinforce vaginal or pelvic floor tissues after hysterectomy has been placed into the pelvic cavity through an abdominal incision. Laparoscopic placement of mesh can also be done. However, more surgeons have begun to use transvaginal placement of mesh, inserting the mesh through the vagina with specialized tools, avoiding abdominal incision entirely.
Complications with Mesh after a Hysterectomy
Transvaginal mesh procedures have been associated with high rates of complications, prompting a safety report by the U. S. Food and Drug Administration (FDA) in July 2011. According to that report, the most common complications include mesh erosion through the vagina, also referred to as protrusion, extrusion or exposure. Pain, infection, bleeding and painful sex are also common, as are organ perforation and urinary dysfunction. Other serious issues identified by the FDA alert include mesh shrinkage, which can cause intense pain, scarring, vaginal shortening and sexual dysfunction; recurrent prolapse; and neuromuscular problems. Many of these complications require additional surgery to resolve, and in many women, multiple procedures have been necessary. However, even repeat surgeries have not been successful in resolving problems in some cases.
Furthermore, the FDA advises, transvaginal mesh procedures have not demonstrated any better clinical results than traditional non-mesh surgeries. The agency advises that surgeons and patients consider safer alternatives to transvaginal mesh surgeries.