Known Mesh Complications
During the last few days I have been trying to spend more time reading about known mesh complications. This is to give women who are injured already a tool to share with family members so that they learn more and understand what has happened to their loved one. Women are frustrated that many do not realize how serious these complications are, and it does not help their struggling situation when they still live in pain for many years. These links are also for women who have not yet been mesh injured so that you can understand it is ALL types mesh causing so many issues.
PURPOSE: We reviewed the mechanisms by which polypropylene mesh changes after implantation in the human body.
MATERIALS AND METHODS: The existing polymer and medical literature was reviewed regarding polypropylene, including its chemical characteristics, and compositional and physical properties, which undergo alteration after implantation at various human body locations. We also reviewed the changes in those physical properties that were demonstrable in explanted specimens.
RESULTS: Polypropylene in mesh form is commonly considered inert and without adverse reactions after implantation in humans. The literature suggests otherwise with reports of various degrees of degradation, including depolymerization, cross-linking, oxidative degradation by free radicals, additive leaching, hydrolysis, stress cracking and mesh shrinkage along with infection, chronic inflammation and the stimulation of sclerosis. Many substances added to polypropylene for various purposes during manufacture behave as toxic substances that are released during the degradation process. The material may also absorb various substances. These alterations in the chemical structure of polypropylene are responsible for visibly demonstrable fiber changes, resulting in the loss of structural integrity through material embrittlement. The heat of manufacturing polypropylene fibers begins the degradation process, which is augmented by the post-production heat used to flatten the mesh to prevent curling and attach anchoring appendages.
CONCLUSION: Based on available evidence the polypropylene used for surgical treatment of various structural defects
is not inert after implantation in the human body. The quest for the perfect mesh must continue.
Abstract: Basic concepts are presented for the use of polypropylene mesh in gynecology for prolapse and stress-incontinence repair. The vagina is a clean-contaminated environment, and it is not possible to insert polypropylene mesh devices without bacterial contamination, despite standard antibiotic usage. Once inserted, the host tissue immediately attaches to the polypropylene and attempts to defend it from bacterial invasion, but if the bacteria have already reached the surface of the device, then dislodgement is difficult. The devices with larger surface areas result in greater bacterial contamination, more polypropylene degradation, increased inflammatory response, fibrous tissue stimulation, and erosion. Non inert polypropylene degrades into potentially toxic compounds that would be expected to stimulate a greater inflammatory reaction leading to erosion. If the physician does not place the mesh below full-thickness vaginal epithelium, penetrates the epithelium during insertion, or if there is hematoma formation near the vaginal incision, then defective healing and erosion may result. Scar tissue causes contraction to less than 50% of the implanted size, which results in dyspareunia and tension on the pelvic mesh attachments. Such contraction may cause pelvic pain and subsequent erosion into adjacent organs. An individual response in fibrosis also exists, with some individuals being “high responders.” Manufacturers need encouragement to develop meshes that are inert and incorporate without contraction along with routine clinical tests to detect “high responders” to avoid complications.
Polypropylene is NOT inert within the human body.
So how do you feel about something that has been implanted, or you are thinking about having it implanted in YOUR body. Women have asked me to give them something that they can take with them to the doctor they are seeing. I can tell you that most will have a huge change in attitude towards you when you take in any mesh information and it won’t be a good one, so there isn’t much point in wasting your paper and ink on too much education. But there will be a few who will agree, so it is worth a try to find one who will treat you without the use of mesh. Just don’t expect miracles and you won’t be hugely disappointed. If I had to do it all over again, I would walk away from any doctor who tried to convince me that the mesh THEY use is a good one. Mesh is mesh!
As for ‘the quest for the perfect mesh must continue’ WE the women of the World are the guinea pigs when mesh is used and we are paying the price of the devastation from all types of mesh. From my own experience it is not worth the risk.