Vaginal surgical mesh: Overview

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• About vaginal surgical mesh
• Vaginal surgical mesh in pelvic procedures

About vaginal surgical mesh

Vaginal surgical mesh is a net-like medical device that can be made of either synthetic or biological materials. There are 4 types:

• absorbable synthetic material  
• non-absorbable synthetic material
• absorbable biological material
  • patient's own tissues (usually from the abdomen wall or leg)
  • tissues from another person
  • animal tissues from cows (bovine) or pigs (porcine)
• composite (a combination of any of these mesh types) 

The design and shape of vaginal surgical mesh differ, depending on the condition that they are intended to repair. Vaginal surgical meshes are designed to allow tissue to grow into and throughout the mesh, thereby creating support for surrounding structures. Once implanted, vaginal surgical mesh is intended to become a permanent part of the body. However, there may be clinical situations that require either partial or full removal.

Vaginal surgical mesh in pelvic procedures

Surgeons may implant vaginal surgical mesh to:

• reinforce the vaginal wall for Pelvic Organ Prolapse (POP) repair
• support the urethra or bladder neck for Stress Urinary Incontinence (SUI) repair

Pelvic Organ Prolapse (POP)

POP is a drop or bulge of pelvic organs and occurs due to weakened tissue and/or muscle, which can no longer support the organs. POP can involve the:

• bladder (anterior compartment)
• uterus (apical compartment)
• rectum (posterior compartment)

There are different degrees of prolapse depending on how far the organ(s) have bulged. Symptoms of POP depend on the type and severity of the prolapse, and can include incontinence, difficulty urinating or painful intercourse. POP can have a significant negative impact on a person’s quality of life.

POP may be treated successfully without the use of mesh. There are non-surgical and surgical treatment options available to manage and treat POP. Discuss these options with your physician to make an informed decision.

Non-surgical management or treatment options for POP may include:

• lifestyle modifications
• perineal rehabilitation (pelvic floor physiotherapy)
• pessary (a device placed in the vagina to help support the vagina, bladder, uterus and/or rectum)

Surgical treatment options for POP may include:

• mesh implanted for treatment of bladder or uterus prolapse
• non-mesh surgical repair

Decisions about the treatment of POP, including whether to use non-absorbable synthetic mesh to treat anterior or apical prolapse, should be made through discussion between individual patients and their health care providers. The Society of Obstetricians and Gynaecologists of Canada and the Canadian Urological Association recommend that surgeons be sufficiently trained and have experience in performing transvaginal (across or through the vagina) surgery for POP repair. This was highlighted in our 2019 Summary Safety Review.

Health Canada's 2019 Summary Safety Review describes that non-absorbable synthetic mesh for the transvaginal surgical repair of anterior (bladder) and/or apical (uterus) prolapse should be used only for the following patients:

• those who have significant risk for recurrence of POP
• those who have experienced recurrent POP
• those for whom alternative surgical treatments are not appropriate

Vaginal surgical mesh devices used for transvaginal repair of posterior compartment POP were removed from the Canadian market in 2019 following the safety review by Health Canada. Compared to other treatment options, we found that the transvaginal implantation of non-absorbable synthetic surgical mesh to treat posterior compartment prolapse (such as the rectum) poses a greater risk of complications. These include pain, repeated infections and mesh erosion (or exposure) through surrounding tissues.

Learn more:

• 2019 Summary Safety Review

Stress Urinary Incontinence (SUI)

SUI in women is a leakage of urine during physical activities that increase abdominal pressure. SUI may occur due to a weakness in the pelvic floor muscles or insufficient closure of the inner muscles of the bladder. Activities that may contribute to SUI include:

• exercise
• coughing
• sneezing
• laughing

The symptoms of SUI vary in severity from minor urine leakage to significant incontinence. These can have a profound impact on a person’s quality of life, as the condition can cause embarrassment, psychological distress, social isolation and loneliness.

SUI may be managed and/or treated successfully without the use of mesh. There are non-surgical and surgical treatment options available to manage and treat SUI. Discuss the treatment options with your physician to make an informed decision.

Non-surgical management or treatment options for SUI may include:

• medications
• incontinence pessary
• lifestyle modifications
• biofeedback/behaviour therapy
• perineal rehabilitation (pelvic floor physiotherapy)

Surgical treatment options for SUI may include:

• non-mesh surgical repair
• suburethral slings (small polypropylene mesh)
• biological slings (sling made of your own tissue)
• transurethral injections (injection of a synthetic compound into the walls of the urethra)