Repair Of Incontinence Without Mesh

What is the Problem with Mesh in the Pelvis?

There are lots of problems with mesh including the risks of erosion of the mesh into adjacent tissue, inflammation around the mesh and chronic pain. Once a complication occurs it can be difficult to remove the sling completely because it sits very deep in the pelvis surrounded by vital structures.

Why is Mesh Used so Commonly in the United States?

It is easy to place with a surgery that can take less than an hour. Because of this many less experienced doctors will offer this surgery to patients.

Is Mesh Banned in the United States?

The FDA has not banned mesh for slings for incontinence but has banned prolapse kits which had been particularly damaging to women. 

What is the Alternative to Mesh?

For incontinence, it is possible to use your own tissue to correct incontinence. I typically use tissue from the front of the abdominal muscles called the rectus fascia to serve as a pubovaginal sling to correct the incontinence for “meshless” surgery.

What is the Advantage to the Rectus Fascia as a Pubovaginal Sling?

The surgery has a high success rate and comes without the risk of uncorrectable chronic pain. By using your own tissue, you do not get inflammation around the mesh.  The body sees the fascia as its own tissue and treats it as such. 

What is the Disadvantage to the Pubovaginal Sling?

The main disadvantage is that it is a bigger surgery that requires more training and experience to place then mesh slings.  Because of this, most patients are not offered this option by their providers to correct their incontinence.

What Can I Expect with Rectus Fascia Pubovaginal Sling Surgery?

Typically patients stay overnight and are discharged home the next day from the hospital.  Patients can have some discomfort which can last a few weeks where the rectus fascia was taken from.  I advise patients to avoid any heavy lifting for 6 weeks to minimize the chance of a hernia developing.