Mesh Medical Device News Desk, July 28, 2016 ~ What to ask the doctor before you have your pelvic mesh removed.
‘Kathleen” is not her real name.
She is a woman who was implanted with transvaginal mesh years ago. Today she is suffering the consequences, including pelvic pain, chronic infections, as well as some autoimmune complications that mysteriously cropped up after she had the implant.
Kathleen has talked to countless doctors about her mesh removal and feels that her experience has helped her become well-versed in the questions that any woman should ask before considering the removal of her pelvic mesh.
First, are you having complications? Unlike what Kathleen is currently going through, many women do not experience complications of pain, chronic infection and mesh erosion, at least not initially. Experienced mesh removal doctors say complications may take years to emerge. According to Dr. Shlomo Raz of UCLA, a leading mesh removal doctor, he is seeing complications up to a decade after an implant.
Some percentage of women have complications initially, but that number is unknown because no one is tracking the big picture. Because the pelvic region is rich with blood vessels, nerves, ligaments and because a mesh implant is a permanent, blind procedure, it is fraught with potential problems.
A surgical nick to the bladder is not uncommon and will eventually heal, but an injury to the colon during the placement of a mesh in the posterior pelvis may not heal. Sepsis is a very real possibility and a serious problem. Sepsis is a very severe and fast moving bacterial infection of the blood that originates from fecal matter. There are also the nerves, which may become impinged by a mesh placement or become encapsulated by scar tissue.
So what should you ask your physician to get the most complete removal in one surgery?
First, make sure he or she is one of the few experts at removing mesh.
Kathleen suggests you sharpen your interview skills and she suggests you bring along a friend. She did. The friend was a woman who had already undergone a removal and a reconstruction of her pelvic floor.
These are suggested questions. Find the words that work best for you but it truly is NOT a time to be shy.
- Do you remove the mesh completely?
Understand that partial removals are the norm by most doctors who snip away a small piece of mesh that has eroded into the vagina, for example. A full removal in one surgery is preferred for the reasons above.
- How can you be sure you’ve removed the mesh in its entirety?
Did the doctor measure the explant to see how many centimeters it contains? By doing the math can he or she determine how much remains behind?
- Do you remove the arms and anchors?
This is an important question because many doctors will not enter into ligaments to further remove the plastic anchors that are dug deeply into the pelvis. In many cases, it may be too dangerous to do so. Ask your doctor what technique is used to remove anchors without causing more harm.
- What diagnostic equipment do you have?
Some doctors like to “see” the pelvic mesh before they go to retrieve it. The transvaginal ultrasound is the only imaging device that will show the mesh, unless it is hidden behind a bone. Make sure a trained technician is operating the equipment to read it accurately.
- Can you do repairs and reconstruction using my own fascia tissue graft within 6 months of removal if needed?
Many doctors do not have the skill to retrieve or harvest fascia from your own body to create a sling that is biocompatible. Make sure your doctor can perform that surgery to treat incontinence or prolapse if it returns.
- How many have you removed, completely?
Make sure the person answers the question you asked and does not include partial removals in his tally.
- Can you predict what reconstructive surgery I will need?
After surgery you may need to follow up to repair any damage done during the removal. How often does this doctor do these surgeries and what will be needed to ensure the best results for you with the least amount of further injury. ##