Abstract

Since 2002 synthetic mesh implants are used to treat patients with pelvic organ prolapse. Because of serious complaints, measures were taken in the Netherlands in 2011-2012. Since then mesh products are only implanted if alternative treatments such as physiotherapy, a vaginal ring and an operation using the body's own tissue were not effective to treat pelvic organ prolapse. In addition, mesh implantation may only take place in a limited number of specialized centers by well-trained recognized specialists. This is because mesh implantation requires experience and precision.

International scientific literature was examined by National Institute for Public Health and the Environment (RIVM) to determine complications that can occur one year or longer after mesh implantation. Complications that were observed in literature were: pain, mesh exposure and erosion, incontinence and pain during intercourse. In addition, a prolapse can recur, for example in another area then where the mesh was implanted. The complication rates varied widely in the literature. Additionally, data on the duration and severity of a complication was limited. This variation and the limited data can partially be attributed to the lack of an unambiguous, international inventory of complications. There is a lot of attention for mesh implants in the international media. Complaints reported to the Dutch Health and Youth Care Inspectorate between 2009 and 2012 demonstrated the occurrence of serious complications. For these reasons, RIVM is calling for a standardized guideline with universal definitions to facilitate the reporting of the complications of mesh implants for pelvic organ prolapse.

In the meantime, newly developed mesh implants entered the market, that are expected to have less complications. In this literature study, identified complications were primarily associated with products that are no longer available on the Dutch market.