Urogynecology Expert Forum
stage 4 rectocele
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Questions in the Urogynecology forum are answered by Bruce Crawford, MD, J. Kyle Mathews, MD, and other medical professionals and experts. Topics covered include overactive bladders, bladder pain, fallen/drooping bladder, bowel urgency, bowel prolapse, cystitis, incontinence, pain with intercourse, rectal prolapse, surgery, urinary urgency, and uterine prolapse.

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stage 4 rectocele

I've had grade 4 rectocele 2+ years, and the bulge is growing. I am scheduled for surgery Dec. 2 by a urogyn at a well-known clinic. Surgeon works with a ob/gyn fellow and said the 15% of his patients have a reoccurence. This urogyn does NOT use mesh when working in the vagina--too many problems.

Mesh horror stories are everywhere, but I also have concerns about suturing old tissue to old tissue, as well as possible bladder/bowel damage. Does no mesh sound like a good option?
I'm 68, 132 lbs., no major medical problems.
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The decision to use mesh or not is a complex one with doctors on both sides of this issue.  

Complications associated with the placement of vaginal mesh are well know and the discussion of those risk are part of the informed consent.  Depending on what mesh is used, absorbable or non absorbable,  and where and how the mesh is placed, anterior vaginal wall ( under the bladder), posterior vaginal wall (over the rectum), place abdominally or vaginally, will affect the complication rate.  

In general, patients and doctors are worried about infection, mesh exposure, mesh erosion, and pain associated with the use of mesh.  

Infection is generally rare but serious if occurs.  The mesh must be removed if infection occurs.  

Mesh exposure is where the mesh is visible usually in the vagina and is often a minor complication that can be handled in an office setting.  Treatment with topical estrogen and trimming of the exposed mesh often is all that is necessary.  

Mesh erosion implies that the mesh has eroded into or through an area.  This can be serious depending on what is involved in the erosion.  Often these need to be surgically removed.  

It should be noted that many times mesh exposure and erosion are used interchangeably.

Pain associated with mesh placement does occur, primarily pain with intercourse, and my require treatment.    

The internet is a poor source for statistics regarding mesh complications and the medical literature is complex.  Reports of Erosion vary from a low of less than 1% to as high as 25% or more.  

Given your surgeon does not believe in the use of mesh, you might get a second opinion from one that does use mesh.  He or she  should be able to provide you with their own percentages of complications and discuss the pros and cons of mesh use.  

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Sincere thanks for an excellent answer covering both sides of the mesh issue.
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