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Mesh Controversies

Non-absorbable polypropylene mesh is used in surgery for a variety of treatments. For example, in general surgery it has been used for decades to repair hernias and has proved very effective in preventing recurrence without significant risks.

Polypropylene mesh is currently used in gynaecological surgery to treat prolapse and urinary incontinence. For most types of operation it has proved effective and safe however for some specific operations (insertion of mesh through the vagina to treat prolapse) a higher risk of complications was found. This type of surgery has largely ceased nationally and has never been part of our routine NHS or private practice. However, we do routinely use polypropylene mesh to treat urinary stress incontinence (i.e. Tension-Free Vaginal Tape (TVT) procedure) and vaginal and/or uterine (womb) prolapse (i.e. laparoscopic hysteropexy and laparoscopic sacrocolpopexy)

Treatment of urinary stress incontinence

In our experience, the most effective treatment for urinary stress incontinence (urinary leakage on exertion) is a polypropylene TVT. This operation uses mesh to support the urethra (outflow tube from the bladder). National Studies and our own audit data confirm that this operation works in approximately 80-90% of women and has proven 17 year outcome data and generally, the risks are low. Details of this operation are explained in a separate leaflet. There are other surgical treatments which do not use polypropylene mesh, although they are either more invasive (i.e. Colposuspension or Fascial sling) or less effective (i.e. urethral bladder neck injections). These operations are available if you prefer.

Treatment of pelvic floor prolapse

In women who have not had a hysterectomy, we use polypropylene mesh in an operation called laparoscopic hysteropexy. This is a keyhole operation and involves reinforcement of uterine ligaments with a small piece of a fine polypropylene mesh to restore the support of the uterus and reduce the prolapse. Our published data has shown no vaginal mesh complications over a 10 year period, reviewing over 500 operations. We found the operation to be safe and effective. The benefit of laparoscopic hysteropexy over conventional surgery (vaginal hysterectomy and repair) includes probable reduced risk of prolapse recurrence and uterine conservation

In women with vaginal prolapse who have had a hysterectomy, we frequently use polypropylene mesh in an operation called laparoscopic sacrocolpopexy. Published results from both Oxford and national studies confirm this operation is safe and effective. There is a small risk of polypropylene eroding into the vagina (1-5% in Oxford). This risk has reduced as our surgical technique has improved.

There are other surgical treatments available to treat the prolapse which do not use mesh (vaginal hysterectomy, vaginal repair and sacrospinous ligament fixation). Specific operation information leaflets are available by going to the Information leaflets page