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Vaginal mesh repair
1. is it superior to natural tissue repair
of pelvic organs prolapse?
Prof. Muhammad Aslam
Department of ObGyn
LGH, Lahore
2. ๏ Up to 40% of females have POP
๏ About 11% of women have surgery
for POP or SUI
๏ Numerous approaches that re-
approximate native tissue
๏ High recurrence rates ~ 29%-40%
with suture only repairs
Vaginal Mesh Repair Prof. Aslam LGH Lahore 2
3. ๏ Increase longevity of repair
๏ Restore anatomy
๏ Prevent recurrence
Vaginal Mesh Repair Prof. Aslam LGH Lahore 3
5. ๏ Extrusion of mesh in the vagina
๏ Erosion into the urinary tract
๏ Bleeding & Infection
๏ Contractures
๏ Gen pelvic pain, Sexual pain
๏ High rate of reoperation as a result
of these complications
Vaginal Mesh Repair Prof. Aslam LGH Lahore 5
10. ๏ Concerns for an increased rate of
complications associated with the
use of vaginal mesh for prolapse
Vaginal Mesh Repair Prof. Aslam LGH Lahore 10
11. ๏ Serious adverse events associated
with mesh use are not rare
๏ Transvaginal mesh placement in
POP repair does not conclusively
improve clinical outcomes over
traditional non-mesh repair
๏ Reclassification to class III devices
Vaginal Mesh Repair Prof. Aslam LGH Lahore 11
12. The Controversy:
๏ Is vaginal mesh safe?
๏ Which mesh to use?
Vaginal Mesh Repair Prof. Aslam LGH Lahore 12
15. ๏ Reports of improved results with
mesh by experienced surgeons
๏ Evidence that mesh improves
objective anatomic outcomes in the
anterior compartment
๏ Significant uncertainty about
safety of mesh procedure
Vaginal Mesh Repair Prof. Aslam LGH Lahore 15
16. ๏ Current data are insufficient to
answer important questions
๏ Well designed RCTs are needed
Vaginal Mesh Repair Prof. Aslam LGH Lahore 16
17. ๏ Routine mesh placement in all
patients is not necessary
๏ Informed consent
๏ Proper training before attempting
mesh repairs
Vaginal Mesh Repair Prof. Aslam LGH Lahore 17