What Can Be Used Instead of Mesh for Prolapse?

Pelvic organ prolapse represents one of the most common yet undertreated conditions affecting women’s health, particularly as they age.

The complications from transvaginal mesh used for vaginal prolapse that prompted the FDA ban highlighted the importance of choosing treatment options that prioritize both effectiveness and safety.

What Is Pelvic Organ Prolapse?

Pelvic organ prolapse occurs when the muscles and connective tissues providing pelvic organ support become weakened or damaged, allowing the bladder, uterus, or rectum to descend into or beyond the vaginal canal.

This condition develops gradually as supportive structures lose their strength due to multiple factors.

Contributing factors and risk elements include, but are not limited to:

• Childbirth stands as the leading cause, with vaginal deliveries causing stretching and potential tearing of pelvic floor muscles and fascia.
• The risk increases with each pregnancy and delivery, particularly with prolonged labor or delivery of large babies.
• Aging and menopause contribute substantially to prolapse development as declining estrogen levels reduce tissue elasticity and strength.
• Additional risk factors include chronic straining from constipation or coughing, repetitive heavy lifting, obesity, and genetic predisposition affecting connective tissue quality.

The severity of pelvic organ prolapse varies considerably among women, classified using the Pelvic Organ Prolapse Quantification (POP-Q) system into stages I through IV.

Stage I genital prolapse remains above the hymen and typically causes minimal symptoms, while stage IV represents complete vaginal eversion with organs protruding beyond the opening.

Common symptoms include a sensation of vaginal bulging or pressure, difficulty emptying the bladder or bowel, urinary leakage, urinary urgency or frequency, and discomfort during sexual intercourse.

Approximately 40-50% of women who have given birth experience some degree of prolapse, though many remain asymptomatic and undiagnosed.

For women suffering from prolapse, the impact on daily life ranges from minor inconvenience to severe disability, affecting work capacity, physical activities, and intimate relationships.

Women with advanced prolapse often report feeling self-conscious about their condition and experience anxiety about prolapse worsening during normal activities.

The Problems with Surgical Mesh for Prolapse

Transvaginal mesh emerged in the early 2000s as surgeons sought more durable solutions for prolapse repair following disappointing recurrence rates with traditional tissue repairs.

Manufacturers marketed these synthetic polypropylene devices as quick, minimally invasive procedures that would provide stronger, longer-lasting support than native tissue reconstruction.

Reported complications from transvaginal mesh are as follows:

• Mesh exposure through the vaginal wall occurred in 10-18% of patients, causing pain, bleeding, and infections requiring revision surgery.
• Women experienced debilitating chronic pelvic pain and painful intercourse as the synthetic material contracted and formed scar tissue.
• Organ perforation during placement damaged bladders, bowels, and blood vessels in numerous cases.
• The FDA received over 1,500 reports of mesh-related complications including bladder injury, leading the agency to declare these complications “NOT rare” in July 2011.
• In January 2016, the FDA reclassified transvaginal mesh for prolapse repair as Class III (high-risk) devices requiring premarket approval.

When Boston Scientific and Coloplast failed to provide safety and effectiveness evidence, the FDA ordered all manufacturers to immediately stop selling transvaginal mesh products for pelvic organ prolapse repair on April 16, 2019.

The litigation consequences proved equally substantial, with more than 100,000 women filing lawsuits against mesh manufacturers including Johnson & Johnson’s Ethicon, Boston Scientific, C.R.

Bard, and others.

Individual jury verdicts reached tens of millions of dollars, with one Philadelphia case awarding $120 million.

Total settlements across manufacturers exceeded $8 billion, making transvaginal mesh one of the largest mass tort litigations in U.S.

history.

Women continue seeking alternatives because vaginal mesh complications persist long after implantation.

Transvaginal mesh removal proves technically challenging and frequently incomplete, with approximately one-third of women experiencing ongoing pain even after the procedure.

Conservative management represents the first-line approach to treat prolapse for many women, particularly those with mild to moderate symptoms.

These non-surgical options offer immediate symptom relief without the risks associated with invasive medical procedures or mesh complications.

Vaginal Pessaries: A Proven Non-Surgical Solution

Vaginal pessaries are medical-grade silicone devices inserted into the vagina to mechanically support prolapsed organs and restore them to their anatomical position.

These removable devices have been used since ancient times, with modern versions offering improved comfort and effectiveness.

Key information about pessary types and effectiveness includes, but is not limited to:

• Ring pessaries work best for mild to moderate prolapse, sitting behind the pubic bone like a diaphragm to provide support while maintaining sexual function.
• Gellhorn and cube pessaries feature more substantial designs for severe prolapse cases, using suction to remain in place when pelvic floor tissues provide inadequate support.
• Studies show initial fitting success rates ranging from 75-90%, with approximately 60% of women continuing pessary use successfully at one year.
• A recent multicenter study of women with advanced stage III and IV prolapse found 90.7% efficacy and 75.3% treatment satisfaction after six months of pessary use.
• The median duration of pessary use extends to 3.3 years, with some women using pessaries successfully for over a decade.

Patient satisfaction remains high among successful pessary users, who report substantial improvements in prolapse symptoms, urinary function, and quality of life.

Self-management programs allow many women to independently remove, clean, and reinsert their pessaries, offering true minimally invasive meshless care while reducing clinic visits and increasing autonomy.

Proper fitting requires professional expertise, typically requiring 2-3 attempts to find the appropriate size and type.

Most women experience mild discomfort and vaginal discharge as minor side effects, manageable with regular cleaning and occasional use of vaginal estrogen cream.

Pelvic Floor Physical Therapy and Exercises

Pelvic floor muscle training (PFMT), including Kegel exercises, strengthens the supportive musculature through targeted contractions and relaxation techniques.

A specialized pelvic floor physical therapist teaches proper technique, as many women initially contract incorrect muscle groups like the abdomen, buttocks, or inner thighs.

Studies and recommended protocols have shown the following:

• The exercise protocol typically involves contracting pelvic floor muscles for 6-8 seconds, relaxing for 6-8 seconds between contractions, and performing 8-12 repetitions three times daily.
• A comprehensive meta-analysis including 13 studies with over 2,000 women demonstrated that those receiving pelvic floor muscle training gained substantially greater improvements in prolapse symptoms.
• The Norwegian POPRACT trial found that women performing supervised pelvic floor exercises showed greater improvement in prolapse stage compared to control groups, particularly for stage II prolapse.
• Benefits proved most substantial for mild prolapse, though women with moderate prolapse also experienced symptom reduction.

PFMT works best when combined with other conservative measures like weight management, treatment of chronic constipation or coughing, and avoiding heavy lifting or high-impact activities.

The exercises prevent further prolapse and may reduce the need for surgical intervention.

If conservative treatments haven’t provided adequate relief and you’re considering surgical options, TruLaw gives immediate answers about eligibility for mesh-related compensation claims.

Contact TruLaw using the chat on this page to receive an instant case evaluation to determine if you qualify to file a transvaginal mesh lawsuit today.

Native tissue pelvic floor repair returns to traditional surgical techniques that predate the mesh era, using only the patient’s own fascia and ligaments to reconstruct support without introducing foreign materials.

This time-tested approach has been performed successfully for over a century and remains the gold standard for many surgeons treating primary prolapse.

How Native Tissue Repair Works

Surgeons performing native tissue repair identify specific fascial defects causing organ descent and repair these using permanent sutures to plicate (fold and reinforce) the patient’s own supportive tissues.

The goal centers on restoring organs to their anatomical position while maintaining vaginal length, caliber, and sexual function.

Native tissue repair procedures include, but are not limited to:

• Anterior colporrhaphy addresses cystoceles (bladder prolapse) by strengthening the anterior vaginal wall through fascial plication.
• Posterior colporrhaphy repairs rectoceles (rectal prolapse) using similar principles applied to the back vaginal wall.
• Vaginal vault suspension treats apical prolapse and uterine prolapse using high uterosacral ligament suspension or sacrospinous ligament fixation.
• Uterosacral ligament suspension offers more anatomical positioning, while sacrospinous fixation provides robust support by anchoring the vaginal vault near the ischial spine.

Recovery from native tissue vaginal surgery typically requires 6-12 weeks of pelvic rest.

Patients avoid lifting over 10 pounds, sexual intercourse, and strenuous activities during initial healing, with most women returning to normal activities within 6-8 weeks.

Research published in the International Urogynecology Journal found 10-year subjective cure rates of 93.9% and objective cure rates of 80.9% following uterosacral ligament suspension, with only 2.1% requiring reoperation for recurrent prolapse.

A Swedish national cohort study tracking over 32,000 women showed reoperation rates of 11.2% at 5 years and 15% at 10 years following native tissue repair.

Benefits and Considerations of Native Tissue Surgery

Native tissue repair offers distinct advantages that make it preferable for many women and clinical situations.

The absence of foreign material eliminates risks of mesh erosion, contraction, exposure, and chronic inflammatory responses.

Advantages and ideal candidates include, but are not limited to:

• Systematic reviews show substantially reduced rates of vaginal erosion (essentially zero for native tissue versus 10-18% for mesh).
• Sexual function typically improves after native tissue repair as prolapse symptoms resolve without mesh-related dyspareunia.
• The procedure preserves all future surgical options if prolapse recurs.
• Best candidates include women undergoing primary prolapse surgery, those with mild to moderate prolapse, and patients who prioritize avoiding foreign materials.

However, native tissue repair carries higher anatomical recurrence rates that may require repeat surgery, with published rates ranging from 20-45% depending on prolapse compartment, severity, and surgical technique.

Many women prefer accepting recurrence risk over mesh-related complications.

Patient selection and surgical expertise substantially impact outcomes, with studies demonstrating that experienced surgeons using meticulous technique achieve better results than less experienced operators.

Contact TruLaw using the chat on this page for an instant case evaluation to see if you qualify to file a transvaginal mesh lawsuit today.

For women with severe or recurrent prolapse who need more durable support than native tissue repair provides, advanced mesh-free surgical techniques offer excellent outcomes without transvaginal mesh placement.

These surgical treatment options use different approaches or alternative materials to achieve robust, long-lasting prolapse correction.

Sacrocolpopexy: The Gold Standard Abdominal Approach

Abdominal sacrocolpopexy represents the most effective surgical treatment for posthysterectomy vaginal vault prolapse, with success rates surpassing all other prolapse procedures.

This operation attaches the top of the vagina or uterus to the sacrum (tailbone) using either biological graft material or the patient’s own tissue as a supportive bridge.

Procedure details and success rates include, but are not limited to:

• The procedure can be performed through traditional open surgery, laparoscopically using small incisions and a camera, or robot-assisted using the da Vinci surgical system.
• Most surgeons now favor minimally invasive surgery that offers comparable outcomes with less blood loss, shorter hospital stays, and faster recovery.
• Success rates for robotic and laparoscopic sacrocolpopexy reach 90-95% at one year, with 75-90% maintaining successful outcomes at 5-7 years.
• A systematic review of robotic-assisted sacrocolpopexy including 27 studies with approximately 1,500 patients reported subjective cure rates of 92-95%.
• Research found 89.3% surgical success rates at 5 years or longer, with no apical failures and reoperation for recurrent prolapse occurring in less than 5% of patients.

The key distinction from banned transvaginal mesh surgery involves the placement route and technique.

Sacrocolpopexy places mesh abdominally through the peritoneal cavity, entirely outside the vagina, avoiding the high erosion rates seen when mesh penetrates vaginal tissue.

The FDA specifically endorsed this abdominal approach while banning transvaginal mesh placement.

Mesh erosion rates remain lower than transvaginal approaches, typically 3-4% rather than 10-18%.

Biological Grafts and Tissue Alternatives

Biological grafts serve as alternatives to synthetic mesh material for women needing additional support beyond native tissue capacity.

These materials provide temporary scaffolding that the body gradually incorporates and replaces with natural collagen during healing.

Available biological graft options include:

• Autologous fascia harvested from the patient’s own body represents the gold standard biological graft, using rectus fascia from the abdominal wall or fascia lata from the thigh.
• Acellular cadaveric allografts use donated human tissue processed to remove all cells while preserving the collagen matrix.
• Animal-derived xenografts from porcine or bovine sources undergo decellularization and cross-linking processes.
• The theoretical advantage centers on gradual remodeling, as the body breaks down the graft over 6-24 months while simultaneously depositing native collagen.

Clinical outcomes with biological grafts show mixed results.

A systematic review published in the American Journal of Obstetrics and Gynecology found no substantial advantages for biological grafts compared to native tissue repair for anterior or posterior prolapse.

Cost considerations substantially impact biological graft use, as processed allografts and xenografts cost thousands of dollars per sheet compared to virtually zero cost for native tissue.

Current clinical consensus on surgical management suggests limited roles for biological grafts, potentially benefiting select patients with severe tissue deficiency.

Contact TruLaw using the chat on this page for an instant case evaluation that can help you determine if you qualify to file a transvaginal mesh lawsuit today.

Beyond general prolapse repairs, certain procedures target specific anatomical defects or coexisting conditions like stress urinary incontinence.

These specialized mesh-free techniques address the root cause of organ descent at particular pelvic locations while avoiding complications associated with transvaginal synthetic mesh implants.

Burch Colposuspension for Bladder Support

The Burch colposuspension specifically treats stress urinary incontinence and anterior vaginal wall descent by suspending the bladder neck and proximal urethra.

British surgeon John Burch developed this retropubic procedure in 1961, and it remains highly effective for properly selected patients.

Procedural details and outcomes include, but are not limited to:

• During Burch colposuspension, surgeons place 2-3 permanent sutures on each side of the urethra through the endopelvic fascia adjacent to the bladder neck.
• These sutures attach to Cooper’s ligament (iliopectineal ligament), a strong fascial structure along the superior pubic ramus.
• The procedure can be performed through open retropubic incision, laparoscopically, or robot-assisted, with operative time averaging 60-90 minutes.
• Long-term success rates range from 70-85% at 5-10 years for stress incontinence cure, comparing favorably with tension free vaginal tape and other synthetic midurethral slings.

A Cochrane systematic review found open Burch colposuspension effective for treating stress incontinence with low rates of serious complications.

The procedure works particularly well for younger women with good tissue quality and coexisting apical prolapse requiring abdominal repair.

The main advantage over synthetic vaginal slings lies in eliminating mesh-related complications like erosion, chronic pain, or infection.

Using only sutures and the patient’s natural anatomy, Burch colposuspension provides durable support without foreign materials.

Pubovaginal Sling Using Autologous Fascia

The pubovaginal sling using autologous fascia treats stress urinary incontinence by creating a supportive hammock under the bladder neck and urethra using the patient’s own tissue.

Surgeons harvest a strip of fascia approximately 10-12 cm long and 1-2 cm wide from the rectus sheath or fascia lata.

Technical aspects and advantages include, but are not limited to:

• Through a small vaginal incision and two small suprapubic incisions, surgeons pass the fascial strip under the urethra and secure the ends to the rectus fascia above the pubic bone.
• The autologous fascial sling serves as a scaffold that the body incorporates through organized fibrosis over several months.
• Success rates range from 70-90% for stress incontinence cure at long-term follow-up, with studies showing sustained effectiveness at 10-year outcomes.
• Major advantages include zero risk of mesh erosion, no foreign body reactions, and compatibility with future procedures if needed.

The procedure takes longer than synthetic midurethral slings due to fascial harvesting, typically 90-120 minutes compared to 20-30 minutes for mesh slings.

Patients experience harvest site discomfort for several weeks following surgery.

Patient selection favors younger women with good tissue quality, those with intrinsic sphincter deficiency requiring robust support, patients who’ve experienced previous mesh complications, and women strongly preferring to avoid all synthetic materials.

Contact TruLaw using the chat on this page to receive an instant case evaluation that can help you determine if you qualify to file a transvaginal mesh lawsuit today.

Selecting among prolapse treatment options requires balancing multiple factors including symptom severity, medical history, lifestyle considerations, personal values, and treatment goals.

Working collaboratively with qualified healthcare providers ensures treatment decisions align with each woman’s unique situation and desired outcomes.

Factors to Consider When Evaluating Treatment Options

Prolapse severity substantially influences treatment selection, with stage I prolapse often responding well to conservative measures and advanced stage III and IV prolapse typically requiring surgical intervention.

Age and reproductive plans vitally impact decision-making, as women planning future pregnancies should strongly consider conservative management or pessaries.

Key considerations when evaluating treatments include, but are not limited to:

• Overall health status determines surgical candidacy, with women having substantial cardiac, pulmonary, or metabolic conditions facing excessive surgical risks.
• Sexual activity considerations matter substantially, as some prolapse treatments preclude vaginal intercourse while others preserve this function.
• Quality of life goals guide treatment intensity, with some women seeking complete symptom resolution while others accept partial improvement with lower-risk approaches.
• Risk tolerance varies considerably among individuals, with some prioritizing avoiding surgical complications even if accepting higher recurrence rates.
• Recovery time and restrictions affect decisions, especially for women with demanding jobs, caregiving responsibilities, or limited support systems.

Recognizing that perfect anatomical restoration doesn’t always correlate with subjective satisfaction helps set realistic expectations.

Treatment reversibility appeals to many women, as pessaries and pelvic floor therapy remain fully reversible while surgical procedures prove more difficult to reverse.

Conservative treatments allow normal activities immediately, while surgical recovery requires 6-12 weeks of restricted lifting, work absence, and activity limitations.

Working With Qualified Healthcare Providers

Consulting pelvic floor specialists rather than general gynecologists often yields better outcomes for challenging prolapse cases.

Urogynecologists complete 3-year fellowships focused specifically on pelvic floor disorders after finishing obstetrics and gynecology residency.

Resources and recommendations for finding qualified care include, but are not limited to:

• The American Urogynecologic Society maintains a provider directory listing board-certified Female Pelvic Medicine and Reconstructive Surgery (FPMRS) specialists nationwide.
• Studies consistently demonstrate that surgeons performing higher volumes of laparoscopic procedures achieve better outcomes and fewer complications than lower-volume operators.
• Seeking second opinions provides valuable perspective, especially when facing major surgical decisions.
• ClinicalTrials.gov lists active prolapse studies recruiting participants, offering access to innovative techniques and rigorous follow-up.

Preparing questions for consultations helps optimize appointment value, including questions about annual surgical volume, complication rates, recommended techniques, and available alternatives.

Most insurance plans cover second opinions, and women shouldn’t feel awkward requesting records to share with another provider.

Knowing realistic expectations prevents disappointment, as no prolapse treatment guarantees permanent cure and recurrence occurs even after excellent surgery.

Contact TruLaw using the chat on this page to receive an instant case evaluation that can help you determine if you qualify to join others in filing a transvaginal mesh lawsuit today.

Our Transvaginal Mesh attorney at TruLaw is dedicated to supporting clients through the process of filing a Transvaginal Mesh lawsuit.

With extensive experience in product liability cases, Jessica Paluch-Hoerman and our partner law firms work with litigation leaders and medical experts to prove how defective mesh implants caused you harm.

Meet the Lead Transvaginal Mesh Attorney at TruLaw

TruLaw focuses on securing compensation for medical expenses, revision surgeries, pain and suffering, lost income, and other damages resulting from your transvaginal mesh injuries.

We provide the personalized guidance you need when seeking justice.

TruLaw’s leadership and track record include, but are not limited to:

• Jessica Paluch-Hoerman: As founder and managing attorney of TruLaw, Jessica brings her experience in product liability and personal injury to her client-centered approach by prioritizing open communication and personalized attention.
• Through TruLaw and partner law firms, Jessica has helped collect over $3 billion on behalf of injured individuals across all 50 states through verdicts and negotiated settlements.

How much does hiring a Transvaginal Mesh lawyer from TruLaw cost?

At TruLaw, we believe financial concerns should never stand in the way of justice.

That’s why we operate on a contingency fee basis – with this approach, you only pay legal fees after you’ve been awarded compensation for your injuries.

If you or a loved one experienced pain, bleeding, infection, organ perforation, mesh erosion, or other complications from transvaginal mesh implants, you may be eligible to seek compensation.

Contact TruLaw using the chat on this page to receive an instant case evaluation and determine whether you qualify to join others in filing a Transvaginal Mesh lawsuit today.

Transvaginal mesh lawsuits are being filed by women across the country who suffered serious complications from pelvic mesh implants used to treat pelvic organ prolapse and stress urinary incontinence. TruLaw is currently accepting clients for the Transvaginal Mesh lawsuit.

Reasons to choose TruLaw include, but are not limited to:

• If We Don’t Win, You Don’t Pay: The Transvaginal Mesh lawyers at TruLaw and our partner firms operate on a contingency fee basis, meaning we only get paid if you win.
• Expertise: We have decades of experience handling product liability cases similar to the Transvaginal Mesh lawsuit.
• Successful Track Record: TruLaw and our partner law firms have helped our clients recover billions of dollars in compensation through verdicts and negotiated settlements.

If you or a loved one suffered pain, infection, bleeding, organ damage, or other complications after receiving a transvaginal mesh implant, you may be eligible to seek compensation.

Contact TruLaw using the chat on this page to receive an instant case evaluation that can determine if you qualify for the Transvaginal Mesh lawsuit today.