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The Elephant in the Room (Let’s Revisit the Mesh Sling topic…again)

April 24, 2017 | Mary South, MD, MHA


The only way to adequately address the topic of transvaginal mesh is to face it head on.  I know there are patients out there who have had a midurethral sling* with mesh that resulted in complications.  Those individuals may wonder why, if we (the surgeons) are aware of those issues, would we continue to offer and perform this procedure for women with stress incontinence?

The answer is that the midurethral sling, in the big scheme of things, results in far more benefit to women compared to the risk of complications.  I would never deny that there can be complications from this procedure.  I spend a significant amount of time counseling my patients on the possible complications. However, complications can occur with any surgical (or medical) procedure.  You can’t have a cataract removed, a hip replaced, a mole removed, or a tooth pulled without potential complications.

As a surgeon who performs this procedure, I see the women that I have placed a sling in return for their post-op checks, and I have seen many other women who have had their slings placed by other surgeons.  The overwhelming majority (more than 95% of patients) are satisfied with the results of their procedure.

If one patient after another came back to me with complications after a sling, I guarantee you I would not continue to do them.  But that is simply not the case.  The most frequent comment I hear from patients is “My only regret is that I didn’t do this sooner.”

I tell my patients I would recommend a sling for stress incontinence to my mother, my sister, my daughter and my friends.  As a matter of fact, one of my friends did come to me for a sling about three years ago, and I asked her to write down her experience so I could post it on this blog.  Here is what she wrote:

“After giving birth to my two children, I developed stress incontinence when I sneezed and coughed. Shortly after that I began taking intense workout classes and noticed the stress incontinence was exacerbated when I jogged, jumped rope and box jumped.  As a healthy, fit 37-year-old, I did not want to settle for dealing with this issue for the rest of my life.  I made an appointment with Dr. South, and she suggested a mesh transvaginal sling surgery.  Dr. South made me feel at ease about the surgery, and there was no doubt in my mind that I wanted to move forward with it.  The surgery went seamlessly.  I had very minimal pain during the healing phase and now three years later, look back and am so thankful that I had the surgery. I can jog, jump rope, and box jump with NO issues.  The sky is the limit, and I no longer feel restrained with the types of physical activity I can participate.  It was simply an amazing process, and I would recommend it to anyone dealing with stress incontinence issues.”

So, stay tuned for my next blog. I will be discussing the complications that can occur with a midurethral sling and how I handle those complications to get patients the results they were hoping for with the surgery.

*Of note, in this blog I am specifically referring to transvaginal mesh in the form of a midurethral sling for stress incontinence.  I am not referring to transvaginal mesh for prolapse repairs.

Find more articles on Bladder Problems, Stress Incontinence