Man-Made Mesh Can't Replace Nature in a Vaginal Prolapse Repair

It's Humbling, But Our Best Man-Made Surgical Mesh Just Doesn't Have the Sort of Strength and Give to Replace Nature in a Vaginal Prolapse Repair (A Blog in Three Parts)

Have you ever skinned a deer? If you've ever skinned, cleaned and separated the cuts of meat on a deer, you probably learned a lot more about internal anatomies and how things are connected inside the body than you ever intended. In case you're thinking that I've started to wonder far from my intended legal topic, let me clarify. I haven't. But a better understanding on internal tissue connections can help you understand more about the issue I'm going to be addressing. That issue involves the medical procedures used to correct a Pelvic Organ Prolapse (POP), often known as a vaginal prolapse. And these procedures are all about tissue connections.

You may have seen the warnings issued by the FDA about transvaginal surgical mesh implantations. You may also have seen the call by Ralph Nader's Public Citizen organization to ban the marketing of these surgical mesh devices until they can be properly tested and approved according to stringent standards. You may be one of the many American women affected by some form of vaginal prolapse. Or you may know someone, or even quite a few people, who have undergone prolapse corrective measures of some form.

If so, you know that prolapse occurs when the strength of interior connective/supportive tissues begins to fail, and a woman's internal organs start to impinge upon or even protrude through the vagina. As many of you may already have occasion to know, vaginal prolapse causes many complications to the sufferer. These complications can include incontinence, painful and difficult urination or bowel movements, and painful sexual intercourse, among other things. Prolapse can change your life and severely restrict your options. You may have to limit your travels or activities to stay near a restroom. You may have to limit activities that expose you to long periods of standing. You may have to tell your significant other "no" more often than you would like.

When vaginal prolapse and its complications become quite severe, doctors often recommend implantation of a surgical mesh or a sling to hold up the internal organs as the woman's own internal tissues once did. The implanted mesh or sling might relieve the pressure on the vaginal structures. Various materials might be used for the meshes or the slings. Surgical mesh implantations usually consist of artificial materials. Slings might consist of the patient's own tissues taken from other bodily areas, or of "cadaver skin."

The cadaver skin comprises treated and processed internal tissues (not necessarily skin, which is too "stretchy" to be properly supportive) that come from animal or human cadavers. Personal anecdotal evidence, as well as some statistics, suggests that cadaver skin slings might give severe vaginal prolapse sufferers better results than surgical mesh implantations. Surgical meshes have been used effectively for decades to teat hernias. But containing a hernia does not present the mesh with the same challenge as supporting a whole suite of internal organs for a prolonged period of time.

What I've been getting to here is that if you've had occasion to see internal anatomy up close (like within an unfortunate deer), you may have noticed that internal connective tissues that have not weakened are immensely strong. In fact, a layer of connective tissue sheathes and protects each muscle. This tissue connects the muscles to the rest of the body. The connective tissue holds all the parts of the deer together internally, and it takes a considerable amount of effort to separate this strong connective tissue from the muscles and other tissues to which it attaches.

Go to Part 2 for discussion of complications from vaginal prolapse surgical mesh implantations.