Macrophages at work, Stonybrook Medicine
Mesh Medical Device News Desk, August 21, 2016 ~ A study published this month is just the latest to confirm that there is an autoimmune response some women experience after a transvaginal mesh implant. It further dispels the notion many doctors believe that vaginal mesh complications are psychological in nature and just in a woman's head.
The research, from McGee Women’s Hospital at the University of Pittsburgh, is published in the August 2016 issue of the American Journal of Obstetrics & Gynecology.
Twenty-seven women underwent mesh removal or excision due to pain or mesh exposure or erosion into the vagina. The explanted mesh was compared to 30 vaginal biopsy specimens from women who did not have a vaginal mesh implant. The women who were experiencing vaginal mesh complications had an elevated inflammatory response to the transvaginal mesh medical device.
Researchers found the excised vaginal mesh had higher levels of macrophages, a type of white blood cell that responds to a foreign body.
An M1 is a macrophage that is proinflammatory leading to chronic inflammation and a ultimately a potential for tissue damage. A M2 macrophage remodels tissue which, if it is ongoing, can result in fibrosis and encapsulating of the mesh.
Fibrosis is essentially scar tissue formation that causes mesh to harden, become rigid. Scar tissue formation can entrap nerves in the process. Fibrosis causes chronic inflammation and that in turn can result in the vaginal mesh shrinking up to 50 percent.
Mesh explanted after 3 mo.
Mesh removed because it was eroding into the vagina had an 88.4% greater response and higher number of macrophages and vaginal mesh degradation. Mesh removed because of pain had a higher number of M2 cells and was consistent with fibrosis.
Researchers believe this bodily response can go on for years.
The latest information about pelvic mesh is part of a growing body of research that may explain why so many women are suffering after they were implanted with polypropylene mesh to treat pelvic organ prolapse or stress urinary incontinence. Some mesh was implanted prophylactically during a hysterectomy 'in case" there was prolapse.
Rectocele, FDA graphic
Very little was known to doctors or patients about pelvic mesh prior to it being approved for market because mesh manufactures were not required by the U.S. Food and Drug Administration to do any clinical trials. Instead vaginal mesh was allowed to be put on the market to treat pelvic organ prolapse or stress urinary incontinence in the mid 1990's with abundant marketing promises and no research to back it up. Doctors and marketers considered accurate placement of the mesh all that was necessary to call it a success.
We are now discovering 20 years later, that the permanent implants may elicit a permanent complication, even when they are removed or partially removed. ##