Specialised Mesh complications service

We offer a committed, patient centred service, with a team of experienced clinicians, physiotherapists, clinical psychologists and specialist nursing staff who work together as a multi-disciplinary team to provide you with the best care, advice, and support.

Mesh complications

The evidence on treating mesh complications is limited and there is no definitive view on the best treatment. Every woman is different, so this information is intended as a guide.

This information explains how we can assess and manage pelvic mesh complications through a range of surgical and non-surgical options.

You and your specialist healthcare team can talk through the options and decide together which option is most beneficial for your own personal situation.

We recommend that you read this information at your own pace, using it as a reference, to guide you through each step of your treatment.

What is Mesh and what type of Mesh have you got?

Vaginal mesh is a surgical mesh that is implanted through the vagina and is commonly used to treat pelvic organ prolapse and urinary stress incontinence.

For stress urinary incontinence, mesh is placed as a sling under the water pipe (the urethra) to support it.

There are different types of mesh sling and the type of sling you have affects what options are suitable for you. Examples of mesh sling are:

Retro pubic mid-urethral mesh sling (for example, TVT)
Trans-obturator mesh sling (for example, TVT-O or TOT)

If you are unsure as to the type of mesh you have, this can be confirmed via your GP or the hospital at which you had your surgery.

Mesh for pelvic organ prolapse

Mesh has been used in different ways to help with pelvic organ prolapse.

Mesh inserted through the vagina

Mesh inserted through incisions in the vagina was used for:

Prolapse of the bladder into the vagina (cystocele).
Prolapse of the rectum into the vagina (rectocele).

Mesh inserted through the abdominal wall

Mesh inserted through incisions in the abdomen can be used for:

Prolapse of the womb (uterus). This procedure is called sacrohysteropexy.
Prolapse of the vagina in women who have had a hysterectomy. This procedure is called sacrocolpopexy.
Prolapse of the rectum. This procedure is called rectopexy.

Symptoms of mesh complications

Pain in the back, tummy, vagina, back passage, leg and inner thigh.
Pain during sex. Your partner can also experience pain if there is an exposed area of mesh in the vagina.
Vaginal discharge or bleeding.
Urinary problems – pain when passing urine, frequent infections, leakage, difficulty passing urine, passing blood in the urine.
Bowel problems – pain when opening bowels, bleeding, passing discharge, loose stool.

Causes of mesh complications

Vaginal mesh erosion

This is when the mesh protrudes through the vagina. It can cause pain, vaginal discharge or bleeding, vaginal infections, or pain/problems having sex.

The mesh can also come through into the bladder or the urethra. This can cause problems including;

Frequent urinary tract infections (Uâ€ŠTâ€ŠIs)
Blood in the urine
Difficulty emptying the bladder
Pain when passing urine or leaking urine or having to get to the toilet quickly.
It can also lead to painful intercourse with your partner.

The mesh sling may be too tight. This can cause problems with emptying the bladder, as well as recurrent infections.

The mesh may become infected causing an open tract (fistula) between your bladder and vagina, or your abdomen or groin.

In the absence of erosion, extrusion or mesh replacement, there may not be an obvious cause for mesh complication.

What to expect at your first clinic appointment

It is very important that you complete the questionnaires sent to you prior to your appointment.

You will meet with a specialist mesh consultant and physiotherapist to discuss complications which have arisen as the result of your mesh implantation.

You will be asked about the problems you are experiencing and how these are impacting your daily life, as well as any previous operations you have had for mesh complications.

You may need to be examined vaginally and/or anally during your consultation. A chaperone will be present if you request this.

We will then discuss an initial plan of treatment with you.

You may find that simply having answers to your questions is appropriate to your needs. If so, we will be able to refer for pain management advice, and treatment for issues caused by your mesh complications.

Some people may have noticed that their mental health has been impacted by their experiences with vaginal mesh. If this is the case, clinical psychology support can be arranged as part of your treatment plan.

It is advisable to bring someone with you to your appointment for support.

Remember to also complete your enclosed bladder diary and bring any results from previous investigations with you.

You will be asked to complete questionnaires at regular intervals through your treatment in order to contribute to a nationally held NHS database regarding mesh complications.

Investigations you are likely to have

If you have had previous investigations, please bring copies of the results with you to your first clinic appointment where possible.

This depends on the problems you are having and the mesh operation or operations you have had. You may need a number of initial investigations to determine the best plan of treatment.

Some of these investigations (urodynamics, LA cystoscopy) may be available at your multidisciplinary clinic visit and be undertaken prior to you being seen by a specialist mesh consultant.

Types of investigation that may be required

The table below gives details of the types of investigation that may be required.

Investigation	Why might you have this test?
Examination under anaesthesia (EUA) – general anaesthetic examination of the vagina or back passage.	To check for erosion of the mesh
Cystoscopy – A telescope test looking inside the bladder and urine pipe. This investigation can be performed under local or general anaesthetic.	Bladder problems such as pain, frequent infections, difficulty passing urine, leakage and/or looking for movement of mesh into the bladder or urine pipe.
Sigmoidoscopy – Telescope test looking inside the back passage. This test is usually carried out under sedation.	This is to check for possible reasons for bowel problems such as pain, passing blood or slime, leakage.
Urodynamics – A bladder test for leakage or difficulty passing urine. This requires the use of a catheter for the duration of the test but does not require any sedation	This test is performed to assess bladder function.
Laparoscopy – Telescope test looking inside the tummy. Small cuts are made in the tummy to insert the telescope. This is performed under general anaesthetic.	To check for scarring caused by mesh resulting in abdominal/pelvic pain.
MRI, ultrasound or CT scan – to look for areas of infection around mesh.	To locate mesh position; to detect movement of mesh into bowel or bladder; to detect abnormal connections between bowel, bladder and vagina (fistula); to detect bone infections

How are mesh complications treated?

Treatments can range from effective non-surgical procedures to major surgery, depending on the type of mesh you have inserted, as well as your treatment wishes and goals. All available options will be discussed in further detail during your consultation.

Treatment for mesh complications can take a long time and be mentally and physically demanding for you and your family. Unfortunately, as with any medical treatment, there is no guarantee that your health will improve.

Points to consider regarding mesh removal surgery:

There is minimal research looking at the benefits of mesh removal.
Surgery to remove mesh can have serious complications including organ injury, heavy bleeding, serious infection, leg and lung clots, worsening pain, and urinary, bowel, and sexual problems.
It is not certain that removing the mesh will relieve your problems.
It might not be possible to remove all the mesh, as this may be difficult to locate, or is in an area where it is too risky to remove (e.g. surrounding blood vessels or nerves).
Removing only part of the mesh may be just as effective. This is usually a smaller operation, but carries the risk that you may still need any remaining mesh removed at a later date, and in some instances removing mesh remnants can be a more difficult surgical procedure.
Urinary incontinence or prolapse is likely to return after the mesh has been removed.
Hernias can occur after mesh removal.

Possible procedures and treatments for mesh complications

There are an array of possible procedures and treatments available through our service, with each treatment plan individualised for personal needs.

There are further a number of helpful websites of which provide further detail on the possible treatments and procedures including the NHS England website and NICE website.

Non-surgical options

Specialist pelvic health physiotherapy

Physiotherapists working in different specialist fields may help you with different aspects of your care. If you decide not to have surgery, physiotherapy can help with a range of mesh complications including bladder problems, pain, and general mobility.

If you decide to have surgery, your physiotherapist will work with you before and after the operation to enhance your recovery.

Specialist pain management

A team of specialist pain management doctors, nurses, physiotherapists and psychologists work together to offer ways to control pain and its impact on your quality of life.

Different approaches are used and these are tailored to you and your pain.

Psychological support

Psychological support could include supporting you to come to terms with complications from surgery, or helping with the adjustment to living with a chronic condition such as persistent pain.

It may also include supporting individuals to overcome difficult feelings such as depression, anxiety, or trauma symptoms associated with their experience of vaginal mesh.

The surgery and the risks

If you decide on surgical treatment for mesh complications, the operation may need to be carried out using a cut through the vagina, stomach or inner thighs.

This depends on the type of mesh operation or operations you may have undergone previously. The aim of the operation may be to remove all or only part of the mesh – this will be discussed with you during your consultation.

The following is a list of possible complications

Incomplete removal of mesh

There is a risk of not being able to remove all of the mesh completely.

This may be due to the following:

Scarring
Risk of injuring other organs like the bowel, bladder, ureter (tube carrying urine from the kidneys to the bladder) or major blood vessels.

Difficulty locating the mesh

Identifying mesh can be difficult, especially if it is small or located in the inner thighs.

New/persisting areas of mesh exposure

New areas of uncovered mesh can occur, especially if there is incomplete removal of mesh.

Continuing pain or new pain

Pain may persist if it is due to scarring of tissue or nerve pain from previous surgery. Pain may also be caused by other problems and not the mesh.

Surgery to remove mesh in such situations may not make pain better or can sometimes make it worse. New pain can also start after surgery due to tissue scarring or if nerves are affected. At least 1 in 3 women will have continuing pain despite complete mesh removal.

Bleeding

There is a risk of heavy bleeding. If this occurs, you may require a blood transfusion. A second operation may also be required to control heavy bleeding.

Damage to internal organs

This can include bowel, bladder, ureter (the urine tube between the kidney and bladder) and blood vessels. These complications are uncommon, but are serious and can prolong your recovery. These injuries are sometimes not detected at the time of surgery and may require another major operation. Damage to bowel or ureter is uncommon, but may require a temporary bag/stoma to drain urine/stool.

Nerve damage

This is uncommon, but can result in pain, leg weakness and abnormal sensation (tingling, numbness, burning). These may be long-term problems.

Leg clots (deep vein thrombosis)

This is a clot in the veins of the leg. It can occur in 4-5 out of 100 patients. A serious problem sometimes occurs when a clot in the leg travels up to the lungs. The risk of clots is reduced by using special stockings and injections to thin the blood.

Recurrence of urinary leakage or prolapse

This depends on why you had the original mesh operation. Urinary leakage or prolapse can occur again in up to 50% of cases, as the supporting mesh is removed. Incontinence can be worse than your original complaint, and is harder to treat.

Bladder over activity

Any operation close to the bladder can make it overactive. This leads to symptoms such as increased urgency and frequency. This can be a new problem, or may cause an increase in symptoms if it was present before your operation. It occurs in about 5 in 100 women.

Infection

There is a risk of infection with any operation. A life-threatening infection is rare. Infections are usually treated with antibiotics but may occasionally need surgery. The risk of infection is reduced by routinely giving you antibiotics during your operation.

Abdominal wall reconstruction

Approximately 10-15% of mesh patients require this. Should this be the case, you may be offered mesh repair rather than mesh removal. This will be discussed with your consultant.

Formation of a Martius Fat Pad

This involves using fat from the labia to ensure a blood supply to the surgical repair. The use of this healthy tissue may improve healing.

Post-operative care

On the ward after the operation

You will have a catheter and a drip when you return to the ward. The catheter is removed after 1 to 2 days, but may be needed for longer. The drip is removed when you can drink normally.

The first couple of days after the operation, bed rest will be encouraged and you will not be able to walk around. Then you will be encouraged to get out of bed and take short walks around the ward. This reduces the risk of blood clots in the legs and improves general wellbeing.

On average, you will stay in hospital for 1 to 4 nights depending on your surgery and recovery.

At home after the operation

Keep mobile to prevent leg clots but avoid heavy lifting for 6 weeks after your operation.

Do not use tampons or have sexual intercourse for six weeks following surgery. You may be worried about resuming sexual relations, and may need to take your time and use lubricants.

Make sure you do not become constipated by drinking plenty of fluids, and eating foods high in fibre such as fresh fruit and vegetables.

You may drive again once you are comfortable and can safely make an emergency stop. You are advised to check with your insurers.

Post-surgery follow up

Following surgery, you will receive a telephone follow up or a face-to-face consultation with the nurse specialist to discuss your general wellbeing and any concerns you may have. We will aim for this to happen 2 – 4 weeks post-surgery.

You will also have either a face-to-face or telephone appointment at 3, 6 and 12 months post-surgery.

You will then have yearly follow up appointments with us or in your local services for a maximum of 5 years.

The information above provides a guide timeline for treatment, but your treatment plan may differ from this. We will discuss post-surgery follow up appointments during your treatment.