Mesh can Destroy your Bladder
A few days ago there was an appeal on another blog I wrote to other women who are living with mesh complications and this was it.
“Please, is there any lady, who had to have urethra or bladder removed because the mesh? This surgery is waiting on me and I am scared if you can, please write me, thank you.”
I actually met this lady who has gone through many surgeries to try to save her bladder and ease the pain, but nothing worked. It is because I had worried about losing my own bladder back in 2013 that I want to help her connect with someone else who has experienced the same this terrible mesh complication. I also tried to find out other research to help her deal with it, although I am not sure it is [possible to deal with it at all. If you put into Google bladder removal you will find many, many links for help with bladder cancer. You will not find a single one because of mesh bladder complications. Not that it does not happen, but because no one talks about it.
Cancer is a terrible illness that has gained acceptance and sympathy over time. People speak of it as they deal with it. But mesh complications NOT cancer and no one wants to talk about it. This should NEVER happen to any women who went through a hysterectomy where mesh was installed in her body, wrapped around her urethra that has destroyed two important parts of her anatomy. Her bladder and her urethra. THIS SHOULD NEVER HAPPEN to any women because of mesh implants.
What makes me so angry is that it is still acceptable in the medical community and mesh is spoken of as the gold standard of treatment in women’s pelvic surgeries. What kind of gold standard would destroy a woman’s bladder and her urethra? ‘Gold’ for who? The mesh manufacturers who make a lot of money from mesh and who will not pay this woman what she really needs to compensate her medical issues for the rest of her life. Or doctors who ignored her when she began having so much pain and then turned her backs on her. Who are these people? What kind of conscience do they have? I say none!
Now this woman is so afraid and needs reassurance from others who have suffered so much and she needs your help to find someone who understand what this surgery is like and the recovery period. So ladies please ask other mesh injured ladies and share this blog so that she and her family will know what to expect. Please leave a comment here for me to forward to her. You do not need to leave your real name but if you leave a legitimate email address perhaps you will both have the support you need.
Of course I began researching to find out what she needs to know before the surgery. The procedure is called a cystectomy and I did find a very informative article written in the U.K which she can read and try to glean what she needs to know. There is a phone number for someone she could contact over there to ask more questions. This is that link
No it is not enough so I kept digging and the sad fact is anything about mesh in the bladder, there are nonstop links for lawyers. So I tried some various spellings to get the info I needed in this country. What I found made me very angry as doctors were once again discussing mesh in the bladder as if it was of little consequence. Could this happen if men were affected like this. I would say definitely not! There would be a huge outcry and the news would hit the media here in the USA. That is why it is important that women begin yelling at the world what is happening to them.
These are paragraphs from an article written by doctors for doctors and they are discussing YOU. I have copied a huge part of it just in case this link is taken down because it made me so angry. Here is why. The last blog I wrote I included a link to an article about a group of Scottish women who are angry how the rhetoric is shifting and words are now being changed to protect the guilty parties who still want to use mesh and continue destroying women’s bodies. I will highlight why it made me so angry and I am sure you will know why.
FIGURE 1 Examination of your referred patient: Mesh is noticeably exposed The recent increase in the use of mesh grafts to reconstruct pelvic anatomy has been directed mainly at improving surgical outcomes. Yet, at the same time, gynecologic surgeons find themselves facing a rise in associated complications of such surgery that they did not see previously.
Among the most troublesome and concerning of those complications are 1) exposure of mesh through the vaginal epithelium and 2) contraction or hardening of mesh (or both) that can result in dyspareunia and chronic pelvic pain. Other, rare complications include infection and fistula.
Our goal in this article is to address the management of graft-healing abnormalities in which a segment of the mesh is palpable or visible, or both, within the vaginal canal. Our focus is on simple abnormalities that can be managed by most generalist gynecologists; to be clear, more complex abnormalities, and those that provoke more serious or lasting symptoms, belong under the care of a specialist.
A recent shift in terminology is significant
Early on, this complication was called “erosion” as understanding of the mechanism of its development grew, however, terminology applied to the problem has changed.
In fact, mesh itself very rarely erodes into the vagina or an underlying viscus. Instead, the complication occurs most commonly as a result of disruption of a suture line—most likely the result of a hematoma or localized inflammation that develops postoperatively.
“Exposure” (our preference here) and “extrusion” are now the recommended terms, based on a consensus terminology document published this year jointly by the International Urogynecological Association and the International Continence Society.1
Exposure of implanted mesh is considered a “simple” healing abnormality because it typically
- occurs along the suture line and early in the course of healing
- is not associated with infection of the graft.2
The typical physical appearance is one of visible mesh along an open suture line without granulation tissue or purulence—again, see FIGURE 1. The mesh is firmly adherent to the vaginal epithelial edges and underlying fascia.
The reported incidence of mesh exposures—in regard to currently used meshes, which are all Type-1, monofilament, macroporous polypropylene grafts—is approximately 10% but as high as 15% to 20% in some reported series.3,4 The higher rates of exposure are usually seen in series in which some patients have had a synthetic graft implanted as an overlay to fascial midline plication. When the graft is implanted in the subfascial layer of the vaginal wall (i.e., without midline plication), however, the reported rate of exposure falls—to 5% to 10%.5-7
Recommendations for management
Most common problem: Exposure
Initially, recommendations for “erosion” management were based on concerns about underlying mesh infection or rejection, and included a need to remove the entire graft. That recommendation still applies to multifilament, microporous grafts that present with inflammatory infiltrates, granulation tissue, and purulence. Although these kinds of grafts (known as “Type-2/3 grafts“—e.g., GoreTex, IVS) have not been marketed for pelvic reconstruction over the past 3 to 5 years, their behavior post-implantation is less predictable—and patients who have delayed healing abnormalities are, therefore, still being seen. It’s fortunate that development of an overlying biofilm prevents tissue incorporation into these types of graft, allowing them to be removed easily.
Exposures related to Type-1 mesh—currently used in pelvic reconstruction—that occur without surrounding infection do not require extensive removal. Rather, they can be managed conservatively or, when necessary, with outpatient surgery. In patients who are not sexually active, exposures are usually asymptomatic; they might only be observed by the physician on vaginal examination and are amenable to simple monitoring. In sexually active patients, exposure of Type-1 mesh usually results in dyspareunia or a complaint that the partner “can feel the mesh.” Depending on the size and the nature of symptoms and the extent of the defect, these commonly seen exposures can be managed by following a simple algorithm.
Palpable or visible mesh fibrils can be trimmed in the office; they might even respond to local estrogen alone. Consider these options if the patient displays vaginal atrophy.
Typically, vaginal estrogen is prescribed as 1 g nightly for 2 weeks and then 1 g two or three nights a week. Re-examine the patient in 3 months; if symptoms of mesh exposure persist, it’s unlikely that continued conservative therapy will be successful, and outpatient surgery is recommended.
When exposure is asymptomatic, you can simply monitor the condition for 3 to 6 months; if complaints or findings arise, consider intervention.
Small (<0.5 cm in diameter) exposures can also be managed in the office, including excision of exposed mesh and local estrogen. If the exposure is easily reachable, we recommend grasping the exposed area with pick-ups or a hemostat and with gentle traction, using Metzenbaum scissors to trim exposed mesh as close to the vaginal epithelium as possible. Local topical or injected anesthesia may be needed. Bleeding should be minimal because no dissection is necessary. Silver nitrate can be applied for any minor bleeding. Larger (0.5–4.0 cm) exposures are unlikely to heal on their own. They require outpatient excision in the operating room.
Preoperative tissue preparation with local estrogen is key to successful repair of these exposures. Vaginal estrogen increases blood flow to the epithelium; as tissue becomes well-estrogenized, risk of recurrence diminishes.
The technique we employ includes:
- circumferential infiltration of vaginal epithelium surrounding the exposed mesh with 1% lidocaine with epinephrine
- sharp circumscription of the area of exposure, using a scalpel, with a 0.5-cm margin of vaginal epithelium (FIGURE 2)
- wide dissection, with undermining and mobilization of surrounding healthy vaginal epithelium around the exposure (FIGURE 3)
- excision of the exposed mesh and attached vaginal mucosa, with careful dissection of the mesh off underlying tissues with Metzenbaum scissors—being careful to avoid injury to underlying bladder or rectum (FIGURE 4)
- reapproximation of mesh edges, using 2-0 polypropylene suture to close the resulting defect so that prolapse does not recur (FIGURE 5)
- closing of the previously mobilized vaginal epithelium with 2-0 Vicryl suture, without tension, to cover the reapproximated mesh edges—after irrigation and assurance of adequate hemostasis (FIGURE 6).
There is more but I left some of it out and will give you the link at the bottom. You will also see graphic photos which I did not care to share here on this blog. Now continue reading
Diffuse vaginal pain after mesh implantation is unusual; typically, the patient’s report of pain has been preceded by recognition of another, underlying pelvic pain syndrome. Management of such pain is controversial, and many patients will not be satisfied until the entire graft is removed. Whether such drastic intervention actually resolves the pain is unclear; again, work with the patient to create realistic expectations before surgery—including the risk that prolapse will recur and that reoperation will be necessary.
Management note: An existing pelvic pain syndrome should be considered a relative contraindication to implantation of mesh.
If you don’t know what contraindication means here is that explanation?
In medicine, a contraindication is a condition or factor that serves as a reason to withhold a certain medical treatment.
Infection of the graft
Rarely, infection has been reported after implantation of Type-1 mesh—the result of either multi-microbial colonization or isolated infection by Bacteriodes melaninogenicus, Actinomyces spp, or Staphylococcus aureus. Untreated preoperative bacterial vaginitis is likely the underlying cause, and should be considered a contraindication to mesh implantation.
Typically, these patients complain of vaginal discharge and bleeding early postoperatively. Vaginal exposure of the mesh results from local inflammation and necrosis of tissue.
Management note: In these cases, it is necessary to 1) prescribe antimicrobial therapy that covers gram-negative and anaerobic bacteria and 2) undertake surgical removal of the exposed mesh, as we outlined above.9
Visceral erosion or fistula
Many experts believe that what is recorded as “erosion” of synthetic mesh into bladder or rectum is, in fact, a result of unrecognized visceral perforation at original implantation. This is a rare complication of mesh implantation.
Patients who experience mesh erosion into the bladder may have lower urinary-tract symptoms (LUTS) of urgency, frequency, dysuria, and hematuria. Any patient who reports de novo LUTS in the early postoperative period after a vaginal mesh procedure should receive office cystourethroscopy to ensure that no foreign body is present in the bladder or urethra.
Operative cystourethroscopy, with removal of exposed mesh, is the management of choice when mesh is found in the bladder or urethra.
Patients who have constant urinary or fecal incontinence immediately after surgery should be evaluated for vesicovaginal or rectovaginal fistula.
The presence of any of these complications necessitates removal of the involved mesh in its entirety, with concomitant repair of fistula. Typically, the procedures are performed by a specialist.
Our experience with correcting simple mesh exposures
During the past year at our tertiary referral center, 26 patients have undergone mesh revision because of exposure, using the technique we described above (FIGURE 2-6). The problem resolved in all; none had persistent dyspareunia. Many of these patients had already undergone attempts at correction of the exposure elsewhere—mostly, in the office, using techniques appropriate for that setting. Prolapse has not recurred in the 10 patients who required reapproximation of mesh edges because of a defect >2.5 cm.
If when you have finished reading all this and you are already a mesh injured women I hope it will make you as angry as I am and you will begin speaking out more so that other women will know what is going on. If you are a woman who has no yet had mesh implanted then I hope it will make you realize that not only can you have crippling nerve damage, constant infections that antibiotics will no longer cure. Hospital stays because you suffer from C-Diff from overuse of antibiotics. Internal infections that could go to sepsis when left untreated and mesh remains inside your body and you die and oh yes, erosion.
Doctors need to start telling the truth, listen to their female patients and refuse to use these products in women that can maim and damage their bodies FOREVER.
And yes and you just may wind up losing your bladder.
If you know anyone or you have had your bladder or urethra removed because of mesh complications, please, please leave a comment so that others will know the dangers.