IS POP SURGERY SHIFTING BACKWARDS?
By Sherrie Palm
The nature of medicine is to progressively shift forward; research continually drives the agenda. Occasionally things come to a screeching halt or fall backwards. Over the course of history, many individuals involved in research were ridiculed or instructed to halt studies but continued to dig, eventually proving their premise to be beneficial.
All transplant and implant scenarios come with risk of rejection, whether human organs or tissues or synthetic products like stents or mesh used for multiple purposes. I have no doubt when Dr. Kugel developed his hernia mesh protocol, he took his share of flack from skeptics. There were without a doubt bugs to work out of “the system” related to product and manufacturing. But hernia mesh is now the gold standard for this repair. There is also little doubt that eliminating transvaginal mesh procedures from the toolbox of fellowship trained urogynecologists and pelvic floor urologists is taking a step in the wrong direction. Do we need to address concerns related to transvaginal mesh-absolutely. But this procedure
should not be stuffed to the back of the closet.
In the POP arena, significant strides have occurred in POP surgical techniques, treatment modalities, exercise regimens, and educational resources in the past few years. As a relatively “new” field gaining recognition and ground every day, it is pivotal that we continue to push the envelope to discover better ways to treat millions of women who suffer from multiple POP symptoms both painful and frustrating. Women want answers and they want them now. I speak with women daily attempting to navigate multiple layers of impact pelvic organ prolapse has to their lives. Most women have physical, emotional, social,
sexual, athletic, and/or work concerns. Every aspect of impact is of great magnitude to women trying to figure out how to help themselves. We need answers.
Despite my continual poking at the media to find a journalist who will step up to the plate and tell “the rest of the story” behind transvaginal mesh concerns, none have come forward. Those of us in the backdrop need to continue to fight the battle in the background; shifting recognition of POP and the treatments available. A couple of fellowship trained practitioners in the POP surgical industry have come forward to express their
thoughts regarding the value of transvaginal mesh treatment. I’d like to share their sentiments with you.
"While I agree that some good things have occurred as a result of the FDA's statement on the use of transvaginal mesh, mainly the decrease in unqualified physicians placing mesh and tightening the approval process for products, it is absurd to come to a conclusion that a mesh used in an abdominal procedure for repair would somehow act differently when placed in the exact same location transvaginally. It is not the mesh or the route of placement, but rather the surgeon that has the most impact on outcomes and complications. " J. Kyle Mathews, MD
“The Ethicon decision is an unfortunate shame. I have used the anterior Prolift product over the past 5 years or so on hundreds of patients with wonderful results because of careful patient selection, pre treatment with topical estrogens and proper surgical technique. My team can do the anterior compartment repair in conjunction with a sling and cystoscopy in under one hour on an ambulatory basis. Our extrusion/exposure rate has been less than 1% and most importantly, the long-term followup has been phenomenal, particularly compared to the colporraphy, which is a suboptimal procedure. Many woman have a preoperative appearance of an introital bulge that looks like a red, rubber ball and two years later on
exam have an absolutely normal vagina in terms of length, caliber and angle, with wonderful support and function. I have been in awe of the terrific results and feel sorry for the patients who will have to seek alternatives to a procedure and a mesh that truly is a winner.” Andrew Siegel, M.D.
My hat is off to these forward thinking pelvic floor specialists; as we continue to talk the talk and walk the walk, I’m hopeful we’ll continue to see advancement in all treatments and procedures for pelvic organ prolapse.