Types of Mesh Implants
Surgical mesh is a medical device that looks like plastic netting and is used to help repair weakened or damaged tissue, provide support for internal organs, help in reconstruction surgeries, and treat traumatic wounds. The device itself may be made from synthetic materials or components derived from biological tissue.
Though surgical mesh can help repair wounds, ease painful symptoms, and restore proper function in the body, in some cases it can also cause additional injuries and infections. Women who have been implanted with surgical mesh — including a bladder sling or other mesh implant—for issues such as pelvic organ prolapse (POP) or stress urinary incontinence (SUI), have reported complications like mesh erosion, extrusion, infections, bleeding, and serious organ damage.
Types of mesh implants
There are a range of surgical mesh products and bladder slings approved for different surgeries and conditions. Transvaginal mesh implants are supplied in various shapes including circular, oval, elliptical, and rectangular sheets, and are available in varying sizes and thicknesses. They may also come in different weights, pore sizes, and level of flexibility. Over the years, manufacturers have designed and produced mesh products to make surgical repair of certain conditions much faster and less invasive.
Some of the more common types of mesh implants include:
- Bladder sling: Typically used to treat SUI, the bladder sling is a strip of mesh that creates a sort of hammock-like support around the bladder and urethra to keep them closed during normal activities, so that women don’t experience unexpected urine leakage.
- Hernia repair mesh: Also called “hernia mesh,” the hernia patch is made to contain an abnormal protrusion of an organ or other tissue and to give the body time to naturally heal.
- Surgical mesh: This is a general term for all types of mesh implants, whether used to repair a hernia, to support organs, to treat POP, or stress urinary incontinence. The shape, materials and flexibility of the mesh varies, depending on its intended use.
- Mesh tape: This is a type of mesh also used to treat stress urinary incontinence, similar to a bladder sling. It’s intended to support the urethra in its normal position to prevent accidental urine leakage. Tension-free vaginal tape is inserted through small incisions in the abdomen and vaginal wall. Transobturator tape is a similar type of product—a narrow strip of surgical mesh that’s placed in the body to support the urethra.
- Mini sling: Like the bladder sling, the mini sling is used to treat SUI, but requires only a single incision. The procedure can be done quickly, within ten minutes, and supports the natural position of the urethra.
Hernia repair mesh
Each type of surgical mesh has its own set of benefits and risks. The hernia repair mesh is the oldest type of surgical mesh, with others developed afterward to be used for different injuries and conditions. The first mesh indicated for hernia repair was polyethylene mesh, introduced in 1958. Since then, many more mesh implants and patches have been created. Hernia repair mesh helps reinforce the abdominal wall or other area around the hernia, allowing for a faster return to activity and a more secure repair. The mesh can also irritate nerves, however, causing post-operative pain, and can create a slightly higher risk of infection.
Mesh implant benefits and risks
Most other types of surgical mesh, outside of those used to repair hernias, are indicated for the treatment of SUI or POP in women. A bladder sling, mesh implant, or mesh tape all work in essentially the same way—by providing additional support and strength to the urethra or other pelvic organs like the bladder, bowel and uterus.
With age, multiple childbirths, and certain types of surgery, a woman’s pelvic muscles and tissues can become stretched and weakened and no longer able to support pelvic organs. Surgical mesh is used in some procedures to help provide additional support so organs aren’t protruding into the vaginal cavity.
When surgical mesh was first introduced as an option for treating conditions like pelvic organ prolapse, it seemed to provide a stronger support for internal organs, and hold them in place more securely than surgery without mesh. Mesh products were also thought to minimize recovery periods, and help alleviate certain types of incontinence.
Some women experienced these benefits, but others suffered severe vaginal mesh complications. In 2011, the FDA released a safety communication warning physicians that transvaginal surgery with mesh could result in complications like severe pelvic pain, erosion, protrusion, infection, bleeding, abscesses, painful intercourse and continued urinary problems. Additional surgeries were not always successful at correcting these complications.
The FDA added that there did not appear to be any advantages to using transvaginal mesh for POP over traditional surgery without mesh.
Manufacturers of surgical mesh
In January of 2012, the FDA ordered manufacturers of mesh implants to perform additional studies to determine the safety of these devices.
Some of the manufacturers of surgical mesh used to repair POP and SUI are:
- Mentor Corporation – ObTape Bladder Sling
- American Medical Systems (AMS) – Apogee, BioArc, Elevate, Mini-Arc, Monarc, Perigee, SPARC, and others
- Boston Scientific – Advantage, Arise, Lynx, Obtryx, Pinnacle, Polyform, Prefyx, and Solyx meshes and slings
- Caldera Medical – Ascend, Desara and Vertessa
- C. R. Bard – Align, Avaulta, Biosynthetic Support System, CollaMend, Pelvicol, Pelvilace, Pelvitex, Ugytex, Uretex, and others
- Covidian – Duo, IVS Tunneler, Parietene, Surgipro
- Ethicon (subsidiary of Johnson & Johnson) – TVT, Prolene, UltraPro Mesh, Gynecare, Gynemesh, Prosima, Prolift
- Sofradim – Pelvetex, Uretex Pubovaginal Sling, Uretex TO, Biosynthetic Support System
- Coloplast – Novasilk, Susped, Exair, Axis, Restorelle Smartmesh
- FDA, Urogynecologic Surgical Mesh Implants http://www.fda.gov/MedicalDevices/ProductsandMedical
- Laparoscopic.MD, Surgical Mesh Used for Hernia Repair http://www.laparoscopic.md/instruments/surgical-mesh
- WebMD, Tension-Free Vaginal Tape Surgery for Stress Incontinence in Women http://www.webmd.com/urinary-incontinence-oab/tension-free-vaginal-tape-for-stress-incontinence-in-women
- Huffington Post, Adam Wolfberg, M.D.: FDA Says 'No More Mesh' for Hernia Repairs - What Are the Consequences? http://www.huffingtonpost.com/adam-wolfberg-md/fda-mesh_b_897907.html