Vaginal Mesh Repair
Vaginal mesh is utilized to surgically repair cystocele (prolapse of the bladder) and rectocele (prolapse of the rectum). During the procedure, polypropylene mesh is placed in either the space between the bladder and vagina (cystocele repair) or the space between the rectum and vagina (rectocele repair).
Using a vaginal approach, the mesh is placed in the correct tissue plane and then a small support device is left in the vagina for 1 week after surgery. The support device is a small pessary that elevates and supports the vagina while the vagina heals and the mesh is incorporated into the tissue. After 1 week, the pessary is removed in the office. If perineal relaxation is present with pelvic organ prolapse, a perineorrhaphycan also be performed at the same time as the prolapse repair.
Patients are typically discharged home the day after surgery, spending one night in the hospital and return to normal activity in 2-3 weeks. Healing is typically complete 6 weeks after surgery. At no time should mesh be felt in the vagina.
Dr. Shashoua performs around 3 vaginal mesh repairs per week. His success rate, as defined by improvement in pre-operative symptoms, is over 85%, with an overall complication rate of less than 5%.
Complications mentioned in the 2011 FDA Safety Communication on Transvaginal Mesh include mesh exposure, mesh contraction, pelvic pain, and painful sexual intercourse. These complications are minimized by meticulously placing the mesh in the correct anatomical plane, and allowing the vaginal support device to elevate the top of the vagina to reduce the risk of over tensioning during surgery.
Vaginal Prolapse Repair with ACell/MatriStem®
Vaginal prolapse repair can also be performed using a special graft called ACell or MatriStem. The surgical technique is very similar to a vaginal mesh repair, except MatriStem is used instead of mesh. MatriStem is placed either in the space between the bladder and vagina or the space between the rectum and vagina. Placement depends on if you have cystocele (prolapse of the bladder), rectocele (prolapse of the rectum) or both. The goal of the procedure is to restore the normal vaginal anatomy as well as repair and rebuild the vaginal tissue.
MatriStem is a unique, biologic graft designed specifically for use in pelvic floor procedures (e.g. repair of cystocele or rectocele). MatriStem is made of a unique porcine basement membrane that has similar features (proteins, collagens, and carbohydrates) to the tissue in the female pelvic floor where the graft is implanted. The structure and composition of MatriStem is particularly beneficial as it allows the body to both re-model its own tissue and regenerate new tissue. After MatriStem has promoted new pelvic floor tissue, it then dissolves. The Matristem graft itself dissolves over a period of months postoperatively at which time remodeling and regeneration of the pelvic floor tissue is complete.