MESH UPDATES

Women navigating pelvic organ prolapse treatment options must decide whether or not to utilize non-surgical or surgical treatment.There truly is no right or wrong choice regarding surgical or non-surgical treatment options; the preference for your personal backdrop is the right choice if it's the right choice for you.

Use of mesh for pelvic organ prolapse surgery can reduce the risk of additional surgery down the road. For those who opt for surgical treatment, APOPS recommends seeking a female pelvic medicine reconstructive surgeon (FPMRS) urogynecologist or urologist. These surgeons specialize in women's pelvic health, pivotal for POP procedures just as an oncologist is for breast cancer or neurologist for multiple sclerosis (MS) or brain tumors-it reducing the risk of complications. A dialogue should be initiated between patient and surgeon whether or not to utilize mesh for your repair. Research your procedure choices, ask your physician ALL questions you have, discuss your options regarding transvaginal mesh repair (through the vagina), robotic or laproscopic procedures, or abdominal mesh repair. In 2011, the FDA issued a warning relating to concerns about transvaginal mesh procedure complications. Urogynecologists and urologists with an  additional 2-3 years of fellowship training are the most logical surgeon choice for these intricate procedures. Additionally, it is a good idea to check the records of your individual physician to make sure you have found the right physician for your specific needs. We all need to know our options; there are choices regarding surgical procedures just as there are options whether or not to utilize surgical procedures at all. Ask all questions you have; a physician who will not take the time to address your concerns with this intricate procedure is not the physician of choice.  

Some urogynecologists and urologists refuse to utilize mesh procedures; it is a personal preference the specialists in the field make on a one-on-one basis based on their individual concerns. A significant percentage of urogynecologists and urologists who utilize mesh feel transvaginal mesh procedures are a beneficial option. I am a woman whose surgical procedure was transvaginal mesh placement in February 2008. I have been very happy with the outcome; as a woman who is extremely active, I wanted my POP repair to be a one time event rather than worrying about potential for additional POP surgical intervention down the road.

Small incisions, proper mesh insertion location, preparation of mesh insertion site, use of estrogen cream pre and post-surgery, degree of mesh tension, and a two layer closure are important considerations for a quality mesh procedure, whether a surgeon performs mesh surgery through a transvaginal, robotic, or abdominal incision.

Articles by Sherrie Palm 

POP Mesh Surgery: Tips for the Best Outcome 3/29/15

Hope on the Horizon 12/3/13

POP Presentation to the FDA OB-GYN Committee 9/8/11

The Mesh Monologue 8/29/11

FDA Pelvic Organ Prolapse Mesh Report; The Rest of the Story

 7/24/2011

Mesh Questions to Ask Your Physician

 


Women who have concerns related to mesh procedures can post their questions to the APOPS Forum, a secure Facebook forum accessible only to members and women's pelvic health clinicians. Women with POP navigating treatment options, women post surgery both with mesh and without, women who prefer to utilize non-surgical treatment options, and multiple healthcare professionals share insights with each other in our protected environment.

As studies on long term efficacy of mesh become available, APOPS will post them on this page.

The Truth Behind Transvaginal Mesh Litigation: Devices, Timelines, and
Provider Characteristics

Long term follow-up of sacrocolpopexy mesh implants at two time intervals at least one year apart using 4D transperineal ultrasound Feb 2016

              ICS/IUGA Prosthesis/Graft Complication Classification Chart

There has been much confusion about the safety of mid-urethral slings because of the controversy related to transvaginal mesh complications. On January 3, 2014, AUGS (American Urogynecologic Society) and SUFU (Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction) approved a jointly developed Position Statement to clarify the safety of midurethral slings.

AUGS/SUFU Position Statement on Mesh Midurethral Slings for Stress Urinary Incontinence

The article below posted on MedPage Today addresses the mesh litigation scams occurring. It is in the best interests of women with mesh complications being encouraged to sign on to class action lawsuits to ask the right questions of attorneys prior to entering into contract to understand their rights and the fee structure. 

Vaginal Mesh Debacle Breeds Questionable Profit Schemes:
A behind-the-scenes look at medical device litigation

Medicines and Healthcare Products Regulatory Agency (MHRA), is responsible for regulating all medicines and medical devices in the UK by ensuring they work and are acceptably safe. On October 28, 2014, they released a report based on their review of mesh implant safety. 

A Summary on the Benefits and Risks of Vaginal Mesh Implants

The link below is the IUGA commentary on the European Commission report regarding mesh. 

IUGA Response