Drugwatch Radio was privileged to have Dr. Christopher Walker of UroGyn Specialists of Florida in the studio to discuss women’s pelvic floor health and to shed some light on issues related to transvaginal mesh. Walker shared his insight on what types of complications women are facing as a result of these products, what to expect after revision surgery and some of the alternative treatments to mesh. He also shared the success stories of women who recovered and regained some quality of life. Here are some of the highlights of the show:
Walker explained that after childbirth, women may suffer from trauma or weakened pelvic muscles. If a woman has a hysterectomy or goes through menopause, the same problems may occur. Transvaginal mesh was originally created to help repair these muscles as well as treat incontinence by supporting the urethra. Unfortunately, the treatment didn’t work so well for some women, and they faced debilitating medical problems.
“We are very, very saddened to see the complications,” Walker said. “We have patients flying in from Michigan, Kentucky … from all over the country. It is the same problem that we see, that being the issue of pelvic pain, as well as erosion of the mesh into the vagina or into a surrounding organ – whether it is the rectum or the bladder.”
One of the most troubling complications is pain during sexual intercourse.
Walker said: “[This] is a very sad condition that affects a number of marriages … and it’s a very difficult condition to treat because the nerves in many cases are damaged.”
According to Walker, the design of some brands of mesh creates a higher risk for these complications because the body rejects the implant. Walker recommends the following tips for avoiding mesh complications:
- Ask the doctor what type of mesh he/she will use.
- Do Internet research on the mesh manufacturer, and find out what their reputation is. For example, are there any lawsuits related to that product?
- Find out about the pore size of the mesh. A larger pore size allows the mesh to better integrate into the body and minimizes the risk of implant rejection.
Walker also stresses that women and their significant others should interview the doctor. How well does he or she know about the product and procedure, and how often does he or she perform these operations? Performing an Internet search for doctor ratings and comments from other patients is also a good indicator of how well a doctor performs.
What to Expect After Revision Surgery
If a woman suffers complications from transvaginal mesh, many times the implant will have to be removed. The procedure is called revision surgery or excision surgery. Walker said that because the mesh was never designed to come out, it must be taken out in stages. Many times, women must go through multiple surgeries to alleviate problems. In cases where there is severe nerve damage, revision surgery will improve the situation, but residual pain may continue.
Walker said that trying to remove every single bit of mesh at once can cause more harm. “We are not going to try and take out the entire mesh kit (in one surgery), just those segments that are causing the trouble,” he said. “We will take out as much volume of the mesh as we can.”
After doctors remove the mesh, they support the organs using the woman’s own tissue or replace the mesh with a biologic product. Walker explained that there are several complications to look out for after revision surgery, both short term and long term.
The short-term complications from revision surgery can include:
- Edema. Because of the extensive nature of the surgery, edema – inflammation and swelling of the tissues – is common.
- Infection. The close proximity to the rectum may encourage the growth of infection. Some signs to look out for include: abnormal vaginal odor and discharge.
- Pain. The extensive nature of the surgery also causes pain.
The long-term complications include:
- Fistulas. These are abnormal connections between two organs. For example, the rectum or bladder may connect with the vagina, causing stool or urine to exit via the vagina.
Women who experience any of these complications should contact their doctor immediately.
Alternatives to Mesh for Mild Prolapse or Incontinence
For mild to moderate prolapse, Walker says there are nonsurgical options and more experienced doctors who “have these options in their tool pan.”
Walker recommends some of the following alternatives to his patients:
- Pessary. These devices are often made of silicone and are designed for self-insertion into the vagina. Walker recommends these for elderly patients. The pessary corrects the anatomy of the patient to relieve prolapse and incontinence. These devices can be removed and re-inserted.
- Pelvic floor therapy. In this nonsurgical technique, electric stimulation (e-stim) is combined with pelvic floor strengthening exercises to help the muscles regain strength and correct prolapse naturally. This treatment helps regrow nerves.
- Hormone therapy and Botox injections. Simple outpatient injections can also help the muscles regain strength and correct prolapse and incontinence.
The complications that women suffer from mesh are life-changing and can take an emotional toll. It can be difficult not to lose hope when facing medical and financial troubles.
However, there is life after mesh, and there is hope.
Walker shared some of his success stories. These are uplifting stories about women who regained their lives after mesh complications.
“There is a lot of hope,” Walker said. “I don’t want any persons listening to our conversation to lose hope. You just have to find a physician who is willing to work with you who will never give up. We can never give up. We first do no harm, but at the same time we need to go beyond and do our best to help you get back to a reasonable quality of life.”
Drugwatch Radio is not a substitute for professional, legal or medical advice. The views and opinions expressed by the host and guests do not necessarily represent those of Drugwatch.