Talking about Slings and Meshes.  There is a difference!
By Marja Sprock, M.D.

Currently there is a lot of talk about vaginal slings and meshes, however most people have some difficulty with the concept and the difference between them. They are often used interchangeably and are definitely a different entity and mostly used for different indications

Both can be made from a “mesh/lace like“ or biologic material, however shape, size and indication for use can be quite different. Slings also called tapes, and meshes are both very important in urogynecologic/pelvic reconstructive surgery. Often patients will tell me they had a mesh implanted for stress incontinence and in reality they mean a sling or the other way around; “the doctor put in a sling” and they had a large prolapse repaired with a mesh/graft. In short: slings are usually used for stress urinary incontinence (SUI) and are quite small. The size of meshes used for prolapse can vary, however it is usually more material than a small sling.

Adjustable minisling for SUI, still with the adjuster arm attached, in place. The small amount of sling will provide stability to the urethra and treat the incontinence. The adjuster arm will be removed.

There is currently not a lot of discussion about the sling used for stress urinary incontinence (SUI), the leakage of urine when you cough, sneeze, walk and laugh. Most people will agree that insertion of a sling after conventional therapy like pelvic floor training-Kegels-has failed, is a good treatment for stress urinary incontinence. No, I am not going to make it more difficult now and discuss all the different slings that are currently on the market. The picture in this article is of an adjustable “minisling”; however there are other options, still with a small amount of artificial material. Treatment success of the surgery for stress incontinence quoted in the literature varies from 65-90%. My experience with the mini adjustable sling has been closer to the latter. Another great benefit of this mini piece of sling is the almost immediate return to regular activity. Only sex will have to wait 6 weeks.

Now let’s discuss the mesh, often used for large vaginal prolapses. Prolapse is when some of the vaginal walls fall down and pull the bladder, rectum, small bowel and/or uterus closer to or through the vaginal opening. Remember the sock being turned inside out. Usually weak tissue and lots of pressure on the prolapse are encountered and often the vagina will need some extra support to prevent it from falling down again.
 

To end all the confusion: meshes/grafts are used for repair of prolapse and a sling/tape is used for stress urinary incontinence.

Turn on the TV nowadays and meshes in the vagina get treated like an unwanted child. The fact that the vagina in which it is used, is broken, gets overlooked. The vagina which will get a large piece of mesh for support is a vagina turning inside out or falling down significantly. The inside–out vagina can be causing pressure, discomfort, difficulty to have bowel movements or urinate or keeping you up urinating the entire night. It has been proven that the chance that the front wall of the vagina comes down again after surgery is less

A mesh on the left and a sling on the right. The difference in size of material is striking.

with a mesh. A mesh, the larger piece of material will recreate support for prolapse. Even though it is definitely a more invasive surgery than a sling/tape, it can often still be done as an outpatient and return to activities like walking is recommended. I am always amazed how quickly people recuperate and how little pain they have after surgery. Sometimes I get a phone call asking if it is normal 3 days after surgery to have some minimal spotting, since patients otherwise feel normal and have no pain. People quickly forget they had surgery and some incisions are required to do the work. Most people are very pleased with their mesh; they often did not realize how the prolapse literally “dragged them down” over the years. As with everything we do in life, there are risks involved. The discussion on TV where some people try to make meshes look bad is not good for the patients with large parts of their vagina protruding down or out.

To have your surgery performed by an urogynecologist who has experience with the use of meshes for prolapse, to diminish the chance of unwanted side effects like material coming through in the vagina-extrusion of mesh, is a prudent decision.

A urogynecologist like Dr. Sprock in Rockledge can offer you not only these vaginal prolapse repairs with mesh and/or sling repair for SUI, but also minimally invasive repairs of vaginal prolapse with meshes brought in through the abdomen with tiny incisions, the sacrocolpopexy. This procedure always requires a mesh, since it will elevate the vagina from above. Dr. Sprock has performed this procedure abdominally, robotically and laparoscopically. Nowadays if a sacrocolpopexy, which will use a mesh, not a sling, is needed, it is done in a minimally invasive way. Just realize that there is mesh and the incisions are smallest in the laparoscopic repair; the robot leaves larger scars and they are in the upper abdomen. To end all the confusion: meshes/grafts are used for repair of prolapse and a sling/tape is used for stress urinary incontinence.

Marja Sprock, MD FACOG, is a fellowship trained urogynecologist in Rockledge, Fl. She trained under Dr. David Richardson at Henry Ford Hospital in Detroit and brings years of experience and a high surgical expertise.  Dr. Sprock will be happy to explain the difference between slings and meshes.

Please call for an appointment at 321-806-3929, send us a note or visit us online at www.CFUroGyn.com.