There are many different types of Mesh being implanted in women on a daily basis.
Polypropylene Mid Urethral Slings (MUS) are by far the most commonly used mesh implants in urogynaecology. They can be implanted retropubically or via the trans obturator approach.
The sling acts like a hammock for a sagging urethra, holding it in place by attaching the ends to a strong, immovable structure. They are generally sold in kits along with their placement devices, stainless steel curved needles resembling large hooks, know as Trocars. The Trocars are used to thread the mesh from one side of the vagina to the other under the urethra in a blind procedure.
These implants are being sold to patients as the Gold Standard despite the fact these devices were brought to market with no high quality randomized controlled trials to support their use. All mesh implants in Australia have now been reclassified as a high risk device.
Many patients were not told that they were being implanted with ‘Mesh’ by their surgeons who often only describe it to patients as a Tape, Ribbon, Hammock or Sling.
As from 1st December 2019, all patients being implanted with mesh in the treatment of SUI MUST be given access to an Implant Card showing the implant used, and a Patient Information Leaflet listing some of the known complications and how to report the complications. Patients must also have been given all the known risks relative to the implant, to enable them to make a fully informed decision about whether to proceed with mesh surgery.
TVT or Tension free Vaginal Tape is commonly referred to as Tape, Ribbon, Hammock or Sling.
The Mesh tape is inserted through an incision in the vagina and then pushed through pelvic tissue to be positioned underneath the urethra. The tape is pulled through two small incisions in the skins surface above the pubic area. As it is pulled through the pelvic muscles and tissue, it causes friction which holds the tape in place (like Velcro). As your body reacts to mesh, your tissues grow through it which permanently holds it in place. The tape is then trimmed beneath the skin’s surface leaving two small scars.
Often referred to as TOT – Trans Obturator Tape. The mesh is inserted through an incision in the vagina and then pushed through the Obturator Foramen and comes out in the crease between the thigh and groin on either side. The mesh is then pulled so it sits under the urethra and the vaginal incision sutured. The excess mesh is then cut just under the surface of the skin inside the thighs leaving two small scars.
POP- Anterior Vaginal Wall Repair
Anterior Repair, as it is commonly called is a procedure used to correct vaginal prolapse. A vaginal prolapse can cause your bladder or urethra to slip down into your vagina causing a bulge.
Anterior wall repair tightens the front wall of the vagina pushing the bladder and urethra back into the correct position. Mesh is inserted to the front wall of the vagina to strengthen it. It is common to also have a mesh sling inserted at the same time. There are many different types of anterior repair kits. To see an example of a removed Anterior mesh click here.
POP- Posterior Vaginal Wall Repair
A prolapse of the back wall of the vagina (posterior) is usually due to a weakness in the strong tissue layers that divides the vagina from the lower part of the bowel.
Posterior repair is a procedure to repair or reinforce the weakened layers between the rectum and the vagina. Mesh is inserted into the back wall to facilitate that. Sometimes anterior and posterior repairs are done together at the same time and most have arms that attach to the ligaments.
Thankfully in recent times, many posterior repairs are being done using stitches rather than mesh.
POP- Sacral Colpopexy
Commonly referred to as Vaginal Vault Suspension surgery. The vault is the name given to the top of the vagina after someone has had a hysterectomy. (The cervix and uterus have been removed).
The supports that normally hold up the top of the vagina are weakened and the vault is falling down like a roof caving in. Vaginal vault suspension restores the vaginal cavity by reinforcing supportive structures within your vagina, pushing the organs back into place.
POP- Sacral Hysteropexy
Sacral Hysteropexy is done to correct uterine prolapse. It involves a resuspension of the prolapsed uterus using a strip of polypropylene mesh to lift the uterus and hold it in place. The uterus is suspended by stitching one end of a strip of synthetic mesh to the
back or around the lower part of the uterus with the other end being stitched or stapled (titanium staples) to a prominent part of the back bone (the sacral promontory) internally.
Ventral Mesh Rectopexy
One of the most common reasons for this
surgery is external rectal prolapse (bowel coming out through the anus). Another reason is internal prolapse or “intussusception,” (when the
rectum collapses in on itself, without coming out of the anus ). During the surgery, the bowel is pulled out of the pelvis and a piece of polypropylene mesh is sewn along the front wall of the rectum and the back wall of the vagina. It is then attached to the back bone (sacral promontory).