Endovaginal Imaging: Vaginal Mesh and Implants

Abstract

Surgical repair for pelvic organ prolapse has traditionally been carried out using native tissue. Over the past three decades, transvaginal mesh implant procedures for prolapse have been developed to reduce the risk of anatomical recurrence. Polypropylene mesh is associated with a higher risk of complications compared with native tissue, including mesh contraction, mesh exposure and extrusion, urinary tract or lower gastrointestinal tract compromise or perforation, and musculoskeletal structure involvement. The 2011 Update to the Food and Drug Administration’s Public Health Notification regarding the use of transvaginal mesh stated that these complications are not rare and can be difficult to treat. Besides history taking and pelvic examination, imaging modalities, especially ultrasonography, are beneficial for diagnosing mesh complications and mapping surgical treatment strategies. Polypropylene mesh is easily visualized with ultrasound, given its pathognomonic appearance. Translabial, endovaginal, and endoanal approaches are useful in determining the location and extent of mesh implants.