MESH REMOVAL DOCTOR IN LOS ANGELES

Vaginal mesh has been used for decades to treat pelvic organ prolapse and stress urinary incontinence. In my practice as a urogynecologist for more than thirty years in Los Angeles, Beverly Hills, and Glendale, I have performed hundreds of mesh procedures and have cared for many women who have done very well after surgery. Mesh can provide meaningful support when pelvic floor tissues are weak, particularly in patients who have had prior failed repairs.

At the same time, a subset of women develops symptoms that appear months or even years later. These symptoms may be subtle at first, or they may significantly interfere with daily life. When that happens, the focus shifts from the original repair to understanding whether the mesh itself is contributing to the problem and whether removal may improve quality of life.

Mesh removal is not automatically the right answer for every patient with discomfort. Careful evaluation is essential. The decision depends on the type of mesh placed, its location, the nature of the symptoms, prior surgeries, and overall health.

 

WHEN MESH MAY BE CONTRIBUTING TO SYMPTOMS

Patients commonly seek evaluation for persistent or worsening pelvic pain, pain with intercourse, recurrent urinary tract infections, vaginal spotting or discharge, a sensation of pulling or pressure, difficulty emptying the bladder, or new urinary urgency and frequency.

Some women have been told that their symptoms are unrelated to their prior surgery. Others assume the discomfort is simply something they must live with. While not every symptom is caused by mesh, persistent changes after implantation deserve thoughtful assessment.

Evaluation may include a detailed pelvic examination, review of prior operative reports, imaging when appropriate, and occasionally cystoscopy to evaluate the bladder or urethra if erosion is suspected.

Recurrent Infections

When mesh becomes exposed or creates chronic irritation, surrounding tissues may remain inflamed. This environment can make bacterial infections more likely and harder to fully resolve. Some patients describe a pattern of temporary improvement with antibiotics followed by recurrence.

If examination reveals mesh exposure or erosion, addressing the source of irritation may reduce the cycle of repeated infections.

Mesh Erosion or Exposure

Mesh erosion refers to exposure of synthetic material through the vaginal epithelium. Less commonly, mesh may erode into adjacent structures such as the bladder or urethra. Symptoms may include bleeding, discharge, irritation, painful intercourse, or recurrent urinary tract infections. In other cases, exposure is found during routine examination.

Small, asymptomatic exposures may sometimes be managed conservatively. Larger or symptomatic erosions often require surgical correction. The extent of removal depends on how much mesh is involved and whether deeper structures are affected.

Chronic Pelvic Pain

Pain after mesh placement can present in different ways. Some patients experience localized tenderness at the vaginal wall. Others describe deep pelvic aching, groin pain, or discomfort radiating along the inner thigh, particularly in cases involving transobturator slings. Mesh contraction or scarring can create tension within the pelvic floor, and in some situations, nearby nerves may be irritated.

It is important to distinguish mesh-related pain from other causes of chronic pelvic pain such as pelvic floor muscle spasm, endometriosis, or bladder pain syndrome. A thorough evaluation helps determine whether removal is likely to improve symptoms.

Mesh Contraction or Displacement

Over time, mesh may contract, tighten, or shift slightly from its original position. This can lead to a pulling sensation, urinary dysfunction, or discomfort with movement. In more complex cases, contraction may contribute to voiding difficulty or dyspareunia.

Each situation requires individualized assessment. The goal is not simply to remove material, but to restore comfort and function while preserving pelvic support whenever possible.

 

TREATMENT CONSIDERATIONS

Mesh removal is not a single standardized procedure. The approach varies depending on whether the original surgery involved a midurethral sling, transobturator sling, sacrocolpopexy mesh, or transvaginal prolapse mesh.

Not every patient requires surgery. Pelvic floor physical therapy can improve muscle coordination and reduce tension that may be contributing to pain. Topical estrogen therapy may improve vaginal tissue health in postmenopausal patients with small mesh exposures. Pain management strategies may also be considered.

If symptoms persist despite conservative measures, or if erosion, obstruction, or significant pain is clearly linked to mesh, surgical intervention may be appropriate.

In some cases, removing only the exposed or symptomatic portion of mesh is sufficient to relieve symptoms. This approach may reduce surgical risk and preserve structural support. More extensive removal may be required if mesh has migrated, eroded into surrounding organs, or is associated with significant pain or infection. Complete removal can be technically complex and is not always necessary to achieve improvement. The decision must balance symptom relief with preservation of pelvic support and bladder function.

 

THE MESH REMOVAL PROCEDURE

Mesh removal may be performed through a vaginal approach or with minimally invasive abdominal techniques, depending on the mesh type and location. Revision surgery often requires meticulous dissection, particularly when scar tissue is present.

During the procedure, the mesh is carefully identified and separated from surrounding structures such as the bladder, urethra, rectum, and pelvic nerves. Precision is critical to minimize injury while addressing the source of symptoms.

In some situations, staged procedures are necessary. Patients with prior multiple surgeries may require a more individualized plan.

Recovery

Recovery varies depending on the extent of surgery. Some patients experience early improvement in symptoms, particularly when exposed mesh is removed. Others notice gradual change over weeks to months as inflammation decreases and tissue heals.

Follow-up care is important to monitor healing and address any residual pelvic floor dysfunction. In some cases, additional pelvic floor therapy after surgery can support long-term recovery.

 

FREQUENTLY ASKED QUESTIONS

How do I know if my mesh is causing my symptoms?
A detailed history and pelvic examination are the first steps. In some cases, imaging or cystoscopy may be necessary. Not all pelvic pain or urinary symptoms are caused by mesh, so careful evaluation is important before considering removal.

Is it possible to remove all of the mesh?
In certain cases, complete removal is possible. In others, full removal may carry additional risk and may not be necessary to relieve symptoms. The appropriate extent of excision depends on the type and location of the implant and the symptoms involved.

Will my prolapse or incontinence return if the mesh is removed?
There is a possibility that support may be reduced after mesh removal. This risk varies depending on how much mesh is removed and the underlying pelvic support. These considerations are discussed in detail before surgery.

Is mesh removal covered by insurance?
In most cases, removal for medically necessary complications is covered. Coverage depends on your specific insurance plan.

How long does recovery take?
Recovery depends on the complexity of the procedure. Many patients resume light activity within a few weeks, but full healing may take several months.

Is mesh removal high-risk surgery?
Revision surgery carries risks similar to other pelvic surgeries, including bleeding, infection, injury to surrounding structures, and recurrence of prolapse or incontinence. The exact risk profile depends on the individual case and prior surgical history