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Mesh Complications & Surgery

Mesh Complications & Surgery

Background, Symptoms, and Causes

The majority of patients who undergo mesh surgery for urinary incontinence and pelvic organ prolapse have successful outcomes. However, serious complications occur in up to 5% of cases and minor complications occur in 20% or more.

The reconstructive surgeons at UroCenter of New York are among the most experienced in the world at treating these complications. Combined they’ve done hundreds, and Dr. Blaivas has the largest published series in the world on urethral reconstruction, a procedure that is often necessary in treating mesh complications (Outcome of Urethral Reconstructive Surgery in a Series of 74 Women). As a result, they are uniquely qualified, not only to treat these terrible conditions, but to avoid them in the first place!

What are mesh complications?

Mesh complications are unexpected consequences of mesh prolapse and incontinence surgery that result in new symptoms that were not present before the surgery. The symptoms of mesh complications include:

1. Difficulty urinating or inability to urinate at all (urinary retention)
2. Urinating too often (urinary frequency) and having to rush to the bathroom – urgency (overactive bladder or OAB)
3. Urinary incontinence
4. Recurring urinary tract infections
5. Pain (including pain during sex)
6. Vaginal discharge or bleeding
7. Bladder stones
8. Ureteral obstruction (blockage to the kidney)

What causes mesh complications?

There are a number of reasons why mesh complications occur. First is the mesh itself. It is a foreign substance and the body may react to it by trying to expel it or cause excessive inflammation or scarring. It is even possible, though unproven, that some people could be allergic to it, and maybe as the mesh degrades, it can become toxic. Second, it can erode into adjacent organs or the vagina. Third, it can form the breeding place for infection. Finally, because mesh surgeries are performed through small incisions with long sharp instruments, it is possible to damage adjacent organs, blood vessels and nerves without the surgeon even knowing it.

Frequently Asked Questions

How are mesh complications treated?

1. Difficulty urinating & urinary retention has two main causes, a blockage from the sling itself and/or a weak bladder. Sometimes, though, it is just a temporary problem from the surgery that will get better by itself.
        Blockage from the sling occurs because the sling is under too much tension – it is too tight. It may have been placed too tightly at the time of surgery or it may have become tighter as the body healed from the surgery. Rarely, the sling may have eroded though the urethra to cause the blockage.
        Treatment of a blockage depends on many factors. If the problem began immediately after the surgery, temporary treatment with a catheter may be all that is necessary while healing takes place. It also may be possible to loosen the sling with a very minor outpatient operation. If these things do not work, it will probably be necessary to perform a more extensive operation to cut the sling or remove part of it. If the blockage occurs because the mesh has eroded into the urethra, this is much more serious and requires a more extensive operation to remove the mesh and reconstruct the urethra.
        Weak bladder: If the bladder muscle is too weak, you may not be able to urinate normally even if there is no blockage from the sling. The best treatment is for you to learn to catheterize yourself to empty the bladder – sounds gruesome, but it’s not and just about everybody can do it without difficulty, (see the section on intermittent self-catheterization). Fortunately, the condition improves in almost everyone within a month or so and then the catheterization can be discontinued.
2. Urinary frequency and urgency (overactive bladder or “OAB”) is most often caused by a bladder infection (cystitis), but it also can be due to a blockage from the sling or even from erosion of the sling into the urethra or bladder. Cystitis is treated with antibiotics. A blockage from the sling or erosion is treated surgically as discussed above.
3. Urinary incontinence (loss of urine control) has three possible causes – (1) a weak urinary sphincter that causes leakage of urine; (2) an involuntary contraction of the bladder that causes you to urinate without control; or (3) a fistula (an abnormal connection between the urinary tract and the vagina that allows the urine to just constantly drip out). If the sphincter is weak, it means that the sling is too loose and you may need another operation to fix that. Involuntary bladder contractions are caused by the same things that cause urinary frequency and urgency (see above). A fistula is usually caused by erosion of the mesh into the urinary tract and requires reconstructive surgery to repair it, but the success rate is very high in the hands of an expert surgeon.
4. Recurring urinary tract infections – bladder infections are very common in women and may not be related to the surgery. Nevertheless, it is prudent to be sure and to check out other causes of which there are many. The most important ones are a urethral blockage by the mesh and erosion of the mesh into the urinary tract, both of which require surgery. If neither of these conditions is found, the next step is to treat the infections with medications and preventative measures that could include medications and probiotics. Other causes of recurring infections include incomplete bladder emptying, urethral and bladder diverticula, and bladder stones all of which can be treated.
5. Pain can be in the lower abdomen or vagina and may be constant or only present during urination or during sex. It may just be the result of normal healing, which results in scar formation, or, it may be due to the mesh itself or even erosion of the mesh. Treatment depends on the particulars of your situation and could involve anti-inflammatory or pain medications, physical therapy, trigger point injections, myofascial release or even surgery to remove the mesh.
6. The cause of vaginal discharge or bleeding is usually apparent on examination. Most of the time it is and infection that can be treated by medication, but it can also be due to erosion of the mesh into the vagina. For patients with small erosions of mesh into the vagina, topical hormones or minor outpatient vaginal surgery may be all that is necessary to achieve a favorable outcome. For extensive erosions, vaginal reconstruction may be necessary.
7. Bladder stones are almost always due to erosion of the mesh into the urinary tract and, if that is the case, surgery will be necessary to remove the stones and the mesh.
8. Ureteral obstruction (blockage to the kidney) is a rare complication of slings that occurs when the mesh is passed into or too close to the ureter. The only treatment is surgical.