Expert Opinion Provided by:
Dr. Jane Smith
Specialty: Obstetrics and Gynecology
About Dr. Smith
Dr. Jane Smith is a urogynecologist who specializes in the care of women with pelvic floor weakness resulting in conditions such as pelvic organ prolapse and bladder dysfunction. She offers personalized treatment options that combine effective long-term results with safe and quick recovery.
- Medical School
Summary to the Patient
PATIENT NAME, thank you for allowing me to review your case and provide my opinion. Before I answer your questions and offer my recommendations, let me summarize your medical history and concerns based on what I have learned from your medical records and the questionnaire you completed.
You are 50 years old and previously underwent a hysterectomy & pelvic floor repair that involved the use of mesh. Following the procedure, you had no issues for several years until recently when you began to experience bleeding. You describe it as “spotting” and have been evaluated by a gynecologist; when she examined you, she saw mesh poking out and referred you to a urogynecologist for further evaluation. The urogynecologist has recommended surgery to remove the mesh.
You are concerned about the bleeding you are experiencing and would like to understand if it is being caused by only the mesh or if some other problem could be involved. You do not want to have unnecessary surgery, and if you do pursue surgery, you want to be sure that you have the most appropriate procedure.
Before I respond to your specific questions, I’d like to provide you with a bit of background information about pelvic organ prolapse.
Pelvic organ prolapse is a condition that happens when tissues that support the organs in the lower belly relax. These tissues are sometimes referred to as the "pelvic floor." When they relax too much, organs can drop down and bulge — or prolapse — into the vagina. Some women with prolapse do not have any symptoms and do not require treatment. Others, however, may experience a fullness or pressure in the pelvis or vagina, a bulge in the vagina, leakage of urine (particularly when laughing, coughing, or sneezing), a sudden need to urinate, or difficulty emptying the bowels. These symptoms can be bothersome and a sign that treatment is necessary.
Treatment for prolapse typically includes pelvic floor muscle exercises or a vaginal pessary, but in women with more severe prolapse, surgery may be indicated. A common procedure, called a sacral colpopexy, is done to correct prolapse at the top of the vagina using a supportive synthetic mesh. Although this type of surgery tends to be highly effective in alleviating prolapse symptoms, over time, the mesh can erode into surrounding tissues such as the vagina and cause other problems.
Questions from the Patient
I'd like to acknowledge the concern that this problem has caused you over the last year. You have asked some very thoughtful questions, and I encourage you to share my responses and recommendations with your physicians as you work on developing a treatment plan.
I just want to know if I'm having the right surgery. Do you agree with what my doctor has proposed? Do I have any other options? What would happen if I do nothing?
I have reviewed the plan of care your doctor has recommended and it is entirely appropriate regarding the type of surgery being proposed. Some women who have mesh erosion choose to cautiously observe the erosion and not undergo further surgery. This may be an option if you are not sexually active and the small spotting or light bleeding is not bothersome to you. If you choose to go the conservative route and simply monitor the erosion (which is entirely acceptable), it is safe and appropriate to use vaginal estrogen supplementation to help the vagina heal. If this fails and you are still bothered by the exposed mesh — either from discomfort with intercourse or bleeding/spotting from the vagina — surgical removal of the exposed mesh would be the appropriate next step.
The only recommendation I would make in addition to what your doctor has suggested is to also perform a cystoscopy (a procedure used to see inside your urinary bladder and urethra — the tube that carries urine from your bladder to the outside of your body) at the time of your exam; this will help ensure the mesh is not causing problems with your bladder and lower urinary tract.
Summary of Next Steps
Thank you, PATIENT NAME, for allowing me to participate in your care. In summary:
- Recommended action #1 details
- Recommended action #2 details
I hope that you find these recommendations helpful and that they serve as the basis for a productive conversation with your treating team. I wish you good fortune with your health.
Links for the Patient
The American Urogynecologic Association has a discussion board for women who have concerns about pelvic floor disorders including mesh related information.