Transvaginal Placement of Surgical Mesh for Pelvic Organ Prolapse FAQs

In July of 2011, the FDA released a Communication warning of potential serious complications associated with transvaginal placement of surgical mesh for pelvic organ prolapse. Dr. Shashoua answers frequently asked questions below.


  • Q: Which procedures use transvaginal mesh?
  • A: All procedures that involve placement of surgical mesh through the vagina.

  • Q: Did the FDA communication include concerns about the use of mid-urethral slings (TVT, TOT)?
  • A: See Mid-Urethral sling for urinary incontinence

  • Q: Is da Vinci Sacrocolpopexy a transvaginal mesh procedure?
  • A: No.

  • Q: What are the risks unique to transvaginal mesh that the FDA refers to and how does Dr. Shashoua minimize these risks?
  • A: The FDA is referring to three sets of risks.
    • Mesh Erosion. This occurs when mesh penetrates the vaginal wall. Rates of mesh erosion are minimized by placing the mesh meticulously in the correct anatomic plane. The goal is for the patient’s tissue to grow around the mesh. When placed correctly, the mesh gets incorporated into the patient’s own tissue keeping the mesh from eroding.
    • Mesh contraction. This occurs if the mesh shrinks after placement leading to pelvic pain and painful sexual intercourse. Rates of mesh contraction are minimized by placing the mesh meticulously in the correct anatomic plane. When placed in the correct space, the patient’s tissue grows around the mesh, keeping it from contracting.
    • Bowel, bladder and blood vessel perforation. Any major operation in the pelvis carries these risks. These risks are minimized by assessing the patient’s risks for developing these complications, being vigilant during the parts of the procedure where these risks may be encountered and using technique that minimizes the occurrence of these perforations.

  • Q: If I had surgery with transvaginal mesh, how would I know if I am having a complication and how would it be managed?
  • A: Complications are easily detected at one of your post-surgical exams at two weeks and six weeks after the procedure. About 2 percent of patients may develop mesh erosion. If this occurs, the erosion can be managed in the office or at an out-patient facility by removing the eroding part of the mesh. If your post-surgical exam is normal at six weeks, you should be free of complications going forward.

  • Q: Why use mesh for transvaginal repair?
  • A: The use of mesh allows for permanent restoration of vaginal anatomy.

  • Q: What if I don’t want a transvaginal mesh procedure?
  • A: Options include sacrocolpopexy where mesh is placed abdominally with the da Vinci robot, vaginal repair with biologic grafts, and traditional vaginal repair without the use of mesh. Dr. Shashoua will discuss each of these options during your visit.