What is Urethral Vaginal Mesh Removal

Urethral vaginal mesh removal is a surgery to take out a sheet of material (mesh) that was previously placed in the pelvis to treat urinary incontinence and pelvic organ prolapse. The mesh is used to help support pelvic organs such as the uterus, bladder, and rectum, which can drop (prolapse) into the vagina. Over time, mesh can break apart, causing new symptoms to appear or old problems to return. Mesh may need to be removed because of:

• Shrinkage.
• Perforation, which is when the mesh moves into any of these areas:
  • The bladder.
  • The part of the body that drains urine from the bladder (urethra).
  • The gastrointestinal (GI) tract.
• Exposure, which is when the mesh comes out through the skin or vagina.

Perforation or exposure may cause:

• Pain.
• Infection.
• Bleeding.
• Problems passing urine (urinary retention).
• Leaking urine (incontinence).
• Pain during sex.
• Fluid leaking from the vagina.

Removing mesh may or may not improve symptoms. Some mesh may be left in to avoid damaging other structures.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Damage to other structures or organs.
• Allergic reactions to medicines or dyes.
• Pain.
• Formation of new, abnormal connections between organs (fistulas).
• Vaginal scarring.
• Blockage (obstruction) of the urinary tract, causing urinary retention.
• Return of the problems that happened before you had the mesh placed. You may need more surgery to fix problems and improve symptoms.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

Ask your health care provider about:

• Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
• Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
• Taking over-the-counter medicines, vitamins, herbs, and supplements.

General instructions

• You may be asked to shower with a germ-killing soap.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• You may have a blood or urine sample taken.
• You may have tests that show the location of the mesh or the problems in your urinary tract. Tests may include:
  • Ultrasound. This uses sound waves to create pictures.
  • Cystoscopy. This involves inserting a thin, tube-shaped instrument with a light and camera at the end (cystoscope) through the urethra, into the bladder.
• Plan to have someone take you home from the hospital or clinic.
• Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Hair may be removed from the surgical area.
  • Your skin will be washed with soap.
• An IV will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
  • A medicine that is injected into an area of your body to numb everything below the injection site (regional anesthetic).
  • Antibiotic medicine to help prevent infection.
• You will lie on your back with your feet in footrests (stirrups).
• A small, thin tube (urinary catheter) will be placed in your bladder to drain your urine.
• Dye may be used to mark the area where the incision will be made, around your urethral opening.
• A U-shaped incision will be made around your urethral opening.
• Small cuts will be made (dissection) in the area until the mesh is seen.
• Tissue will be removed from the mesh, and the mesh will be cut and pulled out. Parts of the mesh may be left in if they are covered with too much tissue (embedded). Removing embedded mesh can cause complications.
• If the bladder or urethra were opened:
  • They will be closed with stitches (sutures).
  • Germ-free (sterile) water may be put into the bladder through a catheter to check for bladder leaks. If leaks are found, more sutures will be placed.
• The area will be cleaned (irrigated) and closed with sutures as needed.
• The outer incision will be closed with sutures.
• Sterile gauze or packing material may be placed into your vagina.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You may have to wear compression stockings. These stockings help to prevent blood clots and reduce swelling in your legs.
• Estrogen cream medicine may be applied to your vaginal area to help with healing.
• You will continue to have a catheter draining your urine, and sterile gauze or packing material in your vagina. These may be removed before you go home.

Summary

• Urethral vaginal mesh removal is a surgery to take out a sheet of material (mesh) that was previously placed in the pelvis to treat urinary incontinence and the dropping (prolapse) of a pelvic organ into the vagina.
• Over time, the mesh can break apart, causing new symptoms to appear or old problems to return.
• Mesh may need to be removed because it moved into pelvic organs (perforation) or it came through the skin or vagina (exposure).
• After mesh removal, the problems that you had before the mesh was placed may come back.

Urethral Vaginal Mesh Removal, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain or discomfort at the incision site, and around your urethral opening. Your urethra is the part of your body that drains urine from your bladder.
• Some fluid (drainage) coming from your vagina. Fluid may become brownish and then a light cream color. Drainage may continue for up to 2 months.
• Problems passing urine, such as not being able to start urinating or feeling like you cannot empty your bladder completely.

Follow these instructions at home:

Medicines

• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed estrogen cream medicine, apply it as told by your health care provider.

Activity

• Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that you are told, until your health care provider says that it is safe.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do not have sex or put anything in your vagina until your health care provider says that this is safe.

Driving

• Do not drive or use heavy machinery while taking prescription pain medicine.
• Do not drive for 24 hours if you were given a medicine to help you relax (sedative) during your procedure.

General instructions

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers. You may only be allowed to take sponge baths.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
  • Drink enough fluid to keep your urine pale yellow.
  • Take over-the-counter or prescription medicines.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have a fever.
• You have swelling or more pain around your incision.
• You have fluid or blood coming from your incision.
• You have pus or a bad smell coming from your incision or your vagina.
• You have more drainage from your vagina.
• You cannot eat or drink without vomiting.
• You continue to have problems passing urine.

Get help right away if:

• You have trouble breathing.
• You have chest pain.
• You have severe pain in your pelvic area or abdomen, and it does not get better with medicine.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

Summary

• After the procedure, it is common to have pain or discomfort at the incision site, some drainage from your vagina, and problems passing urine.
• Do not have sex or put anything in your vagina until your health care provider says that this is safe.
• Contact your health care provider if you have symptoms of infection or other symptoms that do not get better with treatment.