MESH UPDATES

Women navigating pelvic organ prolapse treatment options must decide whether or not to utilize non-surgical or surgical treatment. Women have multiple treatment options. It is imperative women educate themselves about pelvic organ prolapse and all treatment options to better enable themselves to ask their clinicians the right questions, and make informed decisions. Check out the link below for Mesh Questions to Ask Your Clinician. 

Use of mesh for pelvic organ prolapse surgery can reduce the risk of additional or repeat 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), 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 options 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 do not provide 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.

Women who have concerns related to mesh procedures can request entry to and post questions in 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.

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 

60 Minute Mesh Expose: One-sided Noise Generates Fear on Mother's Day

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

Mesh Questions to Ask Your Physician

Every Woman Deserves the Right to Choose or Refuse Mesh  April/16/2014


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

Pro/Con mesh info:

Vaginal Reconstructive Surgery: A Case For and Against Mesh Use

(EAU16) Do we still need meshes for correction of pelvic organ prolapse?

Outside US:

IUGA update on mesh ban in 3 countries

(UK) RCOG and BSUG response to NHS Mesh report

(UK) RCOG Mesh Page

(UK) BAUS Mesh Complication Statement

TGA (Australia) actions after review into urogynaecological surgical mesh implants

IUGA commentary on the European Commission report regarding mesh

ICS/IUGA Prosthesis/Graft Complication Classification Chart

(Scotland) Independent Review of Transvaginal Mesh Implants

(Scotland) The clinical uses of mesh for stress urinary incontinence and pelvic organ prolapse

US:

Surgical Treatment of Female Stress Urinary Incontinence (SUI): AUA/SUFU Guideline

An Update on Existing Guidelines and Position Statements for the Credentialing of Pelvic Surgeons Performing Complex Urogynecological Procedures

Management of Mesh and Graft Complications in Gynecologic Surgery

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

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

Litigation Concerns

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