TVM? TVT? TOT? SIMS? Tape? Sling? Plug? Patch? SUI? POP? WTH@!??

What exactly ARE all these acronyms about?

TVM? TVT? TOT? SIMS? Tape?? Plug? Patch? POP?  SUI??   WTH?!? Speak English, right?

I know, there’s a lot to all this mesh mess, and a lot of unfamiliar terms.  When you first start researching, it’s easy to be left dazed and confused.  So, here is the basic run-down of some commonly used acronyms & terms that are related to surgical mesh:

• TVM = Transvaginal Mesh
  This is surgical mesh that is implanted through the vagina used for various urogynecologic procedures.  TVM mesh includes many types of mesh, some frequently referred to types of TVM include:
  – TVT =  Tension-Free Vaginal Tape, a TVM / sling.
  – TOT or TVT-O = Transobturator Tape, another type of TVM / sling, that goes through the obturator muscles. (This is what I had – the Monarc is a TOT sling, by AMS.)
  – SIMS = Single Incision Mini-Slings, like the “MiniArc”.  These are some of the latest smaller slings on the market – also being called “Tape“.
  – There are also Transvaginal Full-Length or Patch Slings, and the newest term out there is “Tape“.
• Hernia Mesh
  Hernia mesh is often also commonly referred to as a “Patch”, or “Plug”, and there are all different kinds of it.  In this blog, I do not focus on hernia mesh since that is not what I had, and I do not  know as much about it. However, I do know that it is also causing a LOT of problems and pain as well.   It also erodes and breaks down the same way, because it is the same polypropylene material.   There are support groups, for those dealing with horrific problems from hernia mesh too.

but, it’s ALL still MESH
(Please see  the post “Are you a GOOD mesh? or a Bad Mesh?” for more info on recalls, lawsuits, and more.)

Other Mesh-Related Terms and Information:

• SUI = Stress Urinary Incontinence
  If you leak a bit when you laugh, cough, sneeze, jog, or lift something heavy, you may have stress incontinence. This is the most common bladder control problem in younger women.

• POP = Pelvic Organ Prolapse. 
  This includes:
  – Rectocele (prolapse of the rectum)
  – Cystocele (prolapse of the bladder, bladder drop)
  – Enterocele (herniated small bowel)
  – Prolapsed uterus (womb)
  – Vaginal vault prolapse

For details on these conditions see:
http://women.webmd.com/guide/vaginal-prolapse,
where I also found the following statement:

“Approximately 30%-40% of women develop some presentation of pelvic organ prolapse in their lifetime, usually following menopause, childbirth, or a hysterectomy. Most women who develop this condition are older than 40 years. Many women who develop symptoms of a prolapse do not seek medical help because of embarrassment or other reasons. Some women who develop a prolapse do not experience symptoms.”

Most, if not all, of the TVM devices that are on the market today are made from polypropylene, a petroleum-based flexible plastic, and coated with a bovine collagen.  There is a lot of research that shows that this combination causes a inflammatory response in the body, causing the body’s own immune system to attack the mesh.   Many women also experience chronic UTIs (Urinary Tract Infections), inflammation, and FBR (Foreign Body Reaction).  The mesh has been found to NOT be inert.  It hardens, shrinks, and can break down, and “erode”/cut into nearby tissues, ,muscles, through vaginal walls, colons, bladders, urethras, and so much more.  This, of course, causes immense pain, bleeding, problems walking /sitting, and voiding.  These are NOT  easily “manageable” or “minor” complications.

Today, many of the largest manufacturers from all types of TVM products are facing litigation nationwide. There are six multidistrict litigations (MDLs) involving Johnson & Johnson’s Ethicon division, C.R. Bard, American Medical Systems, Boston Scientific, Coloplast and Mentor Corp.  Typically, the manufacturers are being sued, not the doctors using the mesh. (Please see  the post “Are you a GOOD mesh? or a Bad Mesh?” for more info on recalls, lawsuits, and more.)

If you don’t know what kind of mesh you have, the best way to find out is to obtain a copy of your medical records from where the implant surgery was done.

A Brief  History of Surgical Mesh:

(From: http://commonhealth.wbur.org/2011/11/surgery-under-scrutiny-what-went-wrong-with-vaginal-mesh)

Surgical mesh has been used to repair abdominal hernias since the 1950s, the FDA notes. In the 1970s, gynecologists started using mesh products for hernia to do abdominal repair of prolapse. Twenty years later [so the 1990’s], that practice grew to include mesh for stress urinary incontinence and ultimately, prolapse repair with mesh implanted vaginally.

At first, “surgeons would cut the mesh to the desired shape…and then place the mesh through a corresponding incision. Over time, manufacturers responded to this clinical practice by developing mesh products specifically designed for SUI and POP repair,” the FDA wrote in a overview posted in September.

Transvaginal surgery with mesh was considered a more straightforward procedure for doctors not trained in abdominal surgery, says Dr. Samantha Pulliam, associate director of the Division of Urogynecology at Massachusetts General Hospital in Boston. Also, the mesh could be implanted in women whose tissue was simply too weak to use on its own for “native” prolapse repair.

In 2004, the FDA says the first manufacturers were “cleared” to sell ready-to-use mesh “kits” for prolapse repair, which contained specialized tools, surgical instruments and pre-shaped mesh.

These kits were quickly adopted not only by urogynecologists who specialized in pelvic surgery, but also by increasing numbers of general gynecologists.

(Please see http://commonhealth.wbur.org/2011/11/surgery-under-scrutiny-what-went-wrong-with-vaginal-mesh for full article.)

While mesh was created initially to be an improvement over using one’s own tissue,  the “FDA warns there is NO evidence that mesh provided any greater clinical benefit than non-mesh surgeries“.   So, while all surgery has risks, keep in mind that using surgical mesh has the ADDED risk of erosion, and all that goes with that.

The most frequently reported complications from surgical mesh are summed up in the FDA report to include:

“mesh becoming exposed or protruding out of the vaginal tissue (erosion), pain, infection, bleeding, pain during sexual intercourse, organ perforation from surgical tools used in the mesh placement procedure, and urinary problems. Some reports cited the need for additional surgeries or hospitalization to treat complications or to remove the mesh.”

And, while many claim the FDA warnings are only for mesh used for POP, and do NOT apply to mesh slings, tapes, or any mesh used for SUI –  that is not true either.  Please see this post for more information: “Why is it Okay to Use Mesh For SUI, but Too Risky for POP?“.

Please, if you are thinking of having surgery that involves any kind of mesh, please read this post with important information from the FDA and more: “Top 10 Things to Know About Mesh BEFORE Having Surgery for POP or SUI“.

=====================Related links==============

• Top 10 Things to Know About Mesh BEFORE Having Surgery for POP or SUI
• Are you a GOOD mesh? Or a BAD mesh?
• FDA warns there is NO evidence that mesh provided any greater clinical benefit than non-mesh surgeries
• Is it Just Transvaginal Mesh Causing Problems?
• SIMS (Single-incision Mini-slings) Cause Mesh Complications Too
• Are you Sick and Tired of Lawyer Ads about MESH?
• Top 10 Myths Woman are Told Today about Pelvic Mesh
• Finding the Right Doctor for Surgical Mesh Complications

==============Support Groups================

• Women’s POP/SUI TVMesh Complications Support (Closed Group)
• Fighters And Survivors of All Transvaginal Mesh And Hernia Mesh/Plugs (Closed Group)
• Mesh Problems (PUBLIC/OPEN TO ALL, including doctors, etc)
• More resources listed on the footer/main page of this blog!