One medical expert in a recent report expressed alarm that the public may be getting wrong information regarding the issue of surgical mesh used for transvaginal surgeries particularly that of stress urinary incontinence (SUI) repair. Going over some write-ups from different online sources, it would appear that she may have a valid point here.
Pelvic mesh for POP and SUI repairs seems to be used interchangeably by some people. To one who may not be too acquainted with these devices, a mesh for POP may just be as good a mesh for SUI. A little information on these two related devices may be beneficial to a lot of people
Foremost, the surgical procedure to treat SUI should be distinguished from the procedure used to repair POP. The objective of a POP repair is to reinforce the muscles and tissues supporting the pelvic organs in order to prevent the descent of the uterus, bladder, rectum, small bowel, urethra or the top of the vagina from its normal position towards the vagina canal. Mesh sling procedures, on the other hand, are meant to support the urethra and bladder in order to prevent the unplanned leakage of urine.
Surgical mesh used for POP repairs differ from mesh used for SUI in its design and its size. Mesh devices for treating a prolapse are larger and may have different specifications for its mesh material. A vaginal mesh sling, which may also be called bladder mesh, bladder tape, or bladder sling, is smaller in size and comes in the form of a hammock.
While there might be several methods in the repair of SUI, sling procedures using surgical mesh may be done in three ways. First used in 1996, the retropubic method is considered the pioneer in mesh sling procedures. Under this method, the mesh is implanted through a small incision in the vagina under the urethra and exits in two small incisions made in the abdomen just above the pubic bone.
Initial slings used for this approach were the Tension-Free Vaginal Tape (TVT) which may explain why this procedure has also been referred as the TVT sling procedure. Brands marketed under this CatID aside from the Gynecare TVT of Ethicon are Align by Bard, Sparc by American Medical Systems, and Lynx and Advantage by Boston Scientific.
By 2001, another method was introduced which was a slight variation of the retropubic procedure. Called the Obturator approach, mesh was inserted through the vagina but instead of exiting through the abdomen, it used two incisions made in the groin or thigh area. This method was supposed to lower the risk of injury to the bladder and urethra. Bladder slings for this procedure were called the Tension Free Vaginal Tape Obturator (TVT-O) or TransObturator (TOT). Brands sold under this method include the Monarc by AMS, Obtryx by Boston Scientific, Align-TO and Uretex-TO by Bard, and Obtape by Mentor.
The latest procedure to hit the urogynecologic world was the use of mini slings where a shorter pelvic mesh is inserted with only one incision. Launched in 2006, this approach was thought to have become even less invasive and reduces drastically risks of abdominal and groin complications. Brands sold using this approach include the Secur by Ethicon, MiniArc by American Medical Systems, and Solyx by Boston Scientific.
The author has learned that even if a number of doctors and the FDA believed that sling mesh is not as dangerous as vaginal mesh for POP, records will show that there are thousands of women who have filed vaginal mesh lawsuits after sustaining serious injuries associated with sling mesh procedures. You may learn about their ordeals and actions taken by visiting Vaginal Mesh Lawsuits Center at vaginalmeshlawsuitscenter.com
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