THE MESH MONOLOGUE
By Sherrie Palm
You’ve finally taken the steps to approach your primary care physician or ob/gyn about your incontinence concerns or that bulge coming out of your vagina. You’ve been referred to a urogynecologist or urologist and have a definitive diagnosis of type(s) of pelvic organ prolapse. Your journey to health balance is now shifting forward. But when the dialogue starts to flow regarding whether or not to use mesh for repair, you are frozen like a deer in the headlights (yes, I’m from Wisconsin-we use that deer analogy all the time). What to do?
Controversy abounds surrounding mesh use for surgical treatment of pelvic organ prolapse. Recently the FDA issued a press release relating to concerns about transvaginal mesh procedure complications. We all need to know our options; there are choices regarding surgical procedures just as there are options whether or not to utilize surgery for POP treatment at all.
Women on all ends of the mesh spectrum are hitting the panic button, whether newly diagnosed and facing surgery with potential for mesh, already scheduled for surgery and now in a state of high anxiety because mesh surgery was planned, or post surgery and freaking out because mesh was utilized and new concerns have surfaced regarding complications. Step one is take a deep breath. A few basics can go a long way to re-establishing a bit of calm on the mesh frontier.
First let’s cover a bit of basic information. Polypropylene mesh is the same material most stitches are made of; this is not a new product in the medical arena. There are multiple applications for this type of mesh beyond POP surgery including abdominal hernia repair, chest wall repair in thoracic surgery, and hiatal hernia repair.
Mesh utilized in repair of pelvic organ prolapse can be inserted abdominally or vaginally; the transvaginal mesh procedure (through the vagina) is the one being questioned by the FDA. Not all physicians utilize this procedure; some urogynecologists prefer to refrain from use of mesh altogether. The risk of repeat POP surgery however is significant when no mesh is utilized so it is imperative to weigh the options in both directions and have an in-depth dialogue with your physician regarding the particulars of your case prior when making a decision. It is also important to do your homework regarding the physician you choose prior to shifting forward with surgical intervention for POP.
The difference between a transvaginal mesh procedure that turns out well and one that doesn’t is typically how well the mesh has been placed. Location, preparing the site to insert the mesh properly, and adjusting the mesh so it provides the right amount of support-too tight or too loose can create issues-all play a part in how well your procedure turns out. It stands to reason that a physician who has specialized in these procedures and has successfully performed them on a continuing basis will increase the odds of success.
Do your homework ladies-research your physician prior to making your appointment so you have an idea how much expertise he/she has in this arena. Take that list of questions with you to your appointment. Dialogue with your physician about surgical and non-surgical choices. There are no foolish questions; the only silly question is the one that doesn’t get asked.
We’re not trying to regain the bodies we had at 25. Superficial aspects of childbirth like stretch marks don’t rattle our cages; that is a fair price to pay for the miracle of motherhood. We accept the shift in our shapes that comes after bearing children. All we really want is to feel normal again.