APOPS             

MESH

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 decision with surgical or non-surgical treatment options; the preference for your personal scenario 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 specialist (urogynecologist or urologist who specializes in pelvic floor) for your procedure just as you would an oncologist for breast cancer or neurologist for multiple sclerosis (MS) or brain tumors; it reduces the risk of complications. A dialogue should be initiated between patient and urogynecologist 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) or abdominal mesh repair (abdominal incision). Recently 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 beneficial and should remain an option. I am a woman whose surgical procedure was transvaginal mesh placement. 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 post their questions to the APOPS Facebook Chatroom; a link to the Chatroom is on the Home page of the APOPS website. 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.

AUGS has now posted an informed concent for mesh procedures toolkit on their website. Multiple layers of POP mesh agenda are attached, patient handouts, info from AUGS & the FDA, informed consent checklist.

http://www.augs.org/p/cm/ld/fid=174

Insights from Urogynecology/Urology

Unfortunately complications can occur during surgical procedures including transvaginal mesh complications. The most common risks of mesh placement include exposure of mesh material and/or pain with intercourse. The key to decreasing the risk of these complications is to place the mesh properly. This requires the correct surgical technique for dissection (preparing the space within the pelvis in which the mesh will ‘lie’), delivery (bringing the mesh to the optimal attachment sites), and setting or “adjusting” the mesh material. This placement is best done in the hands of physicians who are specialists in this area and who have done numerous procedures.

Clinical research by some physicians demonstrates very favorable results with improvement in anatomy and quality of life, while other studies suggest no benefit and potential risks. Interestingly these studies are often conducted on the very same mesh or procedure, yet yield very different outcomes and conclusions. Understandably the FDA tends to hear from physician groups as well as patients only about the negative outcomes or problems. There are additional studies on large groups of patients, some who've had mesh implanted over eight years ago, that report less that 2% of patients developing any complications. Over 90 % of those patients are reporting very high satisfaction with the results.

Blogtalk Interview Addresses Mesh Concerns

Real Women On Health with Kelley Connors, Dr. Roger Goldberg, Missy Lavender, and Sherrie Palm.

Click here to listen

Articles by Sherrie Palm 

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

The Mesh Monologue

FDA Pelvic Prolapse Mesh Report; The Rest of the Story