The U.S. Food and Drug Administration proclaimed the risks of Implantation of Trans-vaginal Mesh (TVM) in October 2008. It was in October 2008 that the U.S. Food and Drug Administration shared to the public the harm associated with Trans-vaginal Mesh (TVM) implantation.  Pelvic Organ Prolapse (POP) and Stress Urinary Incontinence (SUI) are two conditions that can be treated with TVM implantation.  After an increasing number of incidences about complications brought about by this procedure, the FDA declared safety information about the serious risks of TVM implantation.

The most frequently reported complication is mesh erosion, also called mesh extrusion, protrusion or exposure.  This occurs when the vaginal mesh is exposed through the vaginal skin.  Vaginoscopy, a diagnostic procedure that utilizes an endoscope to view the vaginal canal, is used by physicians to examine and determine the presence of mesh erosion.

Usually, this is caused either by an incision that is not healed completely after the procedure or a low quality surgical mesh material that is implanted.  As studies revealed, women who have low levels of estrogen in their bodies have a high risk in developing this complication.
Some conditions that could induce this complication are history of smoking, past hysterectomy procedures, old age, and mismatch of surgical mesh to the size of the vaginal wall.

There are initial symptoms that signal this complication.  Most frequently, patients experience tightening in the vagina, and most commonly this is associated with dyspareunia and pain while sitting in the same position for a long time. As most commonly recorded, these signs start to appear at least 1 month after the TVM implantation.  Bleeding and foul-smelling vaginal discharges are signs that could be more harmful because these can cause infection.

Treatments vary according to the degree of exposure.  For exposures with 1cm size, these are considered simple erosions and doesn’t require the total removal of the vaginal mesh. Surgeons normally cut off the exposed part of the vaginal mesh and letting the incision site repair on its own. On the other hand, if mesh erosion occurs during healing after the surgery, physicians usually start treating with antibiotics and vaginal estrogen cream. |But if mesh erosion happens some time after while the surgical wound is healing, doctors usually prescribe antibiotic and vaginal estrogen cream treatment. |However, when mesh erosions develop while the tissues of the surgical wound are still in the recovery stage, doctors then use antibiotic and vaginal estrogen cream  as medical care.} But if the exposed mesh is not repaired after two weeks of antibiotic and estrogen cream, the doctor will opt for surgical excision of the mesh.

For an extensive exposure, i.e. when the entire mesh is exposed, the entire vaginal mesh should be removed.   Physicians would then be inclined to recommend a new procedure to treat POP and SUI.

Careful management is needed in mesh erosions since these complications recurs most of the time. Majority of the patients who have experienced mesh erosions went through a number of corrective mesh repairs that are painful and debilitating.  However, this complication can be prevented from recurring.  Patients should carefully watch their activities during recovery period and visit their doctors monthly to check any sign or symptoms of possible mesh erosion after TVM implantation.

References:
http://blogs.webmd.com/womens-health/2011/08/vaginal-mesh-new-fda-warnings.html
http://www.icsoffice.org/Abstracts/Publish/105/000870.pdf
http://www.empowher.com/sexual-well-being/content/vaginal-mesh-erosion-part-2?page=0,2