Frequently asked Questions about Mesh Reconstruction
Q: I have had a prolapse for many years. Is this the right operation for me ?
Before contemplating any treatment we need to ensure the diagnosis is right and we are making the best decision possible. This is done by asking lots of questions, an examination of the support mechanisms in the vagina and then an ultrasound to exclude any other pathology.
Q: What can you tell from such a simple clinical examination ?
The clinical examination is designed to identify which areas are weak and descend when the patient strains. This is done by inserting a speculum and looking separately at the front, middle and back of the vagina. Sometimes this is clear by simply inspecting the introitus.
Q: What are the non surgical options to treat prolapse ?
Depending on your diagnosis and what options are available non surgical treatments include:
- Electromagnetic induction therapy - click here for more information
- Pelvic floor training - click here for more information
- Vaginal oestrogen - click here for more information
- Hormone supplements - click here for more information
Q: Why should I try these options first ?
In general they are safe and simple treatments whilst surgery has uncommon but serious side-effects.
Q: What are the arguments in favour of using a global approach ?
This is a difficult decision. The global approach is best when the underlying damage is such that correcting one problem is highly likely to lead to another significant prolapse developing soonafter. However, this has to be balanced against the increased risk of complications following a more extensive surgical procedure.
Q: What are the arguments against Total Vaginal Reconstruction with Mesh
- There is no long term data to support such an operation
- This is a completely new technique that is untested
- Randomised controlled trials have not been done to compare this treatment with existing treatments
- There may be an unacceptable risk of complications including mesh erosion, sexual dysfunction, bladder and bowel dysfunction
Q: Why are you offering me this operation if there is not enough evidence that it works.
A large number of these type of procedures have been done by surgeons around the world over the last 20 years. Results of these surgeries are being reported at clinical meetings and in the literature and doctors are now arguing about the various techniques and incidences of problems.
I offer this procedure to patients based on analysis of information available at the time of treatment. A decision to undertake this operation is made with full awareness of the risks of the operation. In my experience to date:
- this technique is the most exciting development in the treatment of prolapse in the last 50 years
- outcome data of the alternative procedures (abdomino-pelvic sacrocolpopexy, laparoscopic sacral fixation) suggests a much better outcome and a reduced morbidity from this new operation
- careful auditing of surgery has led to consistent improvements in technique, prosthetic materials and post operative care over the last five years
- older alternative procedures are also liable to result in significant risks and complications
Q: What are the actual risks of these procedures ?
| Complication | Figures quoted in the literature: | Dr Farnsworth's Clinic 2006-2007 |
| Mesh erosion | 10-30% | less than 5% |
| Sexual dysfunction | up to 40% | less than 5% |
| Bladder/bowel dysfunction | up to 10% | less than 5% |
| Stress incontinence | 20-30% | 20-30% |
In August 2008 Dr Farnsworth began using the most recent available mesh, the AMI Advanced Pelvic Repair System. There have been no reported mesh complications in the first 85 cases in Sydney and 200 cases in Europe.
Q: What is a mesh erosion ?
Mesh erosion can be due to rejection and extrusion of mesh after surgery or it can be due to failure to heal the skin over a mesh implant. This can also be due to movement of mesh and breakdown of the overlying skin.
Figure 1: Mesh erosion in the anterior vaginal wall after mesh reconstruction surgery. This type of erosion is usually repaired easily by excising the small area of mesh and sewing the skin edges back together.
Q: What about rejection of the mesh ?
This was a problem with some of the earlier meshes but is now extremely rare with the modern low density wide weave polypropylene meshes that are now available.
Q: What about sexual dysfunction ?
Some studies have found a high rate of sexual dysfunction after mesh surgery but this has not been reported in Dr Farnsworth's clinic. Our reported data has reported an overall improvement in sexual function.
It is important to note that there are a number of causes of sexual dysfunction. Any mesh complication, scar formation, defective healing or movement of the mesh due to excessive activity, constipation or premature sexual activity can have serious consequences. One of the most important causes of sexual dysfunction is failed previous surgery of any type.
Q: Why do so many patients have leakage after prolapse surgery ?
Prolapse is often associated with significant tissue damage and loss of sphincter function. Correction of the prolapse may then reveal leakage. This is a controversial area. Many doctors advocate combined prolapse and incontinence procedures at the same time but Dr Farnsworth prefers to fix each problem separately.
Q: Why does Doctor Farnsworth prefer not to operate for prolapse and incontinence at the same time ?
Dr Farnsworth prefers to correct prolapse first and in most cases incontinence resolves as well. In some patients further surgery will be necessary, usually a day surgery procedure to insert a sling such as the TVT Secure.
Click here to read more about the TVT Secur sling
Q: Is a sling guaranteed to fix the problem ?
No, but the success rate is over 90% If a sling does not work we have to work out why it didn't work and then decide what to do next. Sometimes a sling was put in incorrectly or it has moved since surgery. If this has happened a repeat sling may be an option and this is not usually a problem. On other occasions the sling is fine and the problem is due to another diagnosis such as a poor quality urethra or sphincter weakness where a completely different treatment may be needed.
Q: What is the risk of bowel leakage ?
This is an uncommon but significant problem in some patients. It occurs when a prolapse operation corrects any rectal emptying problems but it is then discovered that there is sphincter weakness or damage, which must be addressed separately.
Q: Is there any way I can ask some questions without actually having to see the doctor ?
Yes. Telephone the main office in Wahroonga on 02 94738555 and ask to talk to Robyn, our nurse.