Transvaginal Mesh

Differences between mesh erosion, mesh extrusion, and mesh exposure.

One of the most common problems women have after pelvic mesh implantation is the mesh protruding into their vagina or surrounding organs.  This painful complication is related to healing problems and infection at the site of the mesh and can take years to arise.  Symptoms of this complication include pain in the pelvic area, bulging organs or tissue protruding from the vagina, and pain during intercourse.  If you’ve experienced this problem, your doctor may have used the term “mesh erosion,” “mesh extrusion,” or “mesh exposure.”  So, what’s the difference between these terms?

The simple answer is, not a lot.  There are no uniform terms for classifying healing abnormalities and the terms “erosion,” “extrusion,” and “exposure” are poorly defined.  If a woman discovers mesh protruding from her vagina or into her bladder, for example, her doctor may call it any one of these terms.  Basically, these terms all simply refer to mesh moving to a place where it’s not meant to be, which can have serious and often painful consequences.

In addition to the term for this complication varying, its treatment also varies depending on its severity.  The doctor may merely “trim” the exposed mesh or may try and remove it completely.  However, treatment of mesh erosion/exposure/extrusion is often not simple and can involve multiple surgeries to remove the entirety of the mesh.  Which course a doctor chooses largely depends on the severity of the erosion/exposure/extrusion.  The more severe the complication, the more likely the doctor will choose to remove it completely.  For example, if the doctor finds mesh in the bladder, it is likely he or she will remove the entire thing.  Unfortunately, the doctor may not be able to get all of the mesh out and parts may be left behind.  The pain also may not stop even after removal of the mesh.

Surprisingly, no long term studies have been done into the effects of pelvic mesh after implantation.  Mesh manufacturers often cite to short term studies in support of the widespread use of mesh, but multiple experts have questioned whether these studies actually support permanent implantation of mesh given the fact that they followed the patients for a few years at most.  These studies also use different terms to describe the complication, but many do not describe the severity of the complication, making it difficult to assess how serious the erosion/exposure/extrusion was.  Numerous experts have expressed the need for studies on mesh complications with a longer follow up time, yet mesh manufacturers continue to point to studies studying complications for only a short time.

All in all, “mesh erosion,” “mesh extrusion,” or “mesh exposure” are all terms for the same painful complication and their usage varies by the doctors who use them, as well as the experts who study them.  Treatment options likewise vary depending on the severity of the complication.  No matter the name, pelvic mesh moving to a place it’s not supposed to be, can have serious and permanent consequences for the women implanted with it.

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