Transvaginal Mesh
Pelvic Prolapse
Most important, I am willing to examine any of my patients who have had mesh implantation for urethral sling to treat stress urinary incontinence, or implantation of mesh to support fallen bladder or rectum, also called anterior and posterior repair. I will gladly see you at no charge, just tell the receptionist when you call why you wish to be seen.
An FDA safety communication: Update on serious complications associated with transvaginal placement of surgical mesh for pelvic organ prolapse which was issued on July 13, 2011, has raised concerns about risks with procedures many of you have undergone. The FDA issued this update because complications with surgical mesh devices have been reported. Importantly, the warning applies to transvaginal implantation for repair of pelvic organ prolapse (anterior and posterior repair ) and not implantation for treating stress incontinence. Physicians and patients understand that complications can occur with any surgical procedure and that complications are more common with implantation of foreign material. It is critical to understand the risk of that complication, not just that a complication can occur. The information published does not include the number of patients treated to compare to the number of complications so assessing the risk is very difficult. My assessment from using mesh for years and reviewing literature not referred to by the FDA, is that the advantages of using mesh for urethral slings for stress incontinence or to reinforce anterior and posterior repairs include:
• Using mesh is much less invasive and with faster recovery than other non-mesh procedures for stress incontinence.
• The implantation of mesh for additional support for cystocele and rectocele or apical prolapse has become popular because the failure rates with non-mesh repairs are quite high.
• The transvaginal mesh repair is less invasive than transabdominal surgery and often transabdominal surgery does not treat the same kind of prolapse.
• Proper patient selection, careful surgical technique, and addressing the problems early greatly reduce the risk of serious complications.
You can access the pertinent publication by the FDA and some responses by the American Urological Association at www.auanet.org. In the “Search Site” box, just type in “mesh” and click “go”.
If you have concerns, please call. Again, I shall be happy to see any of my patients who had mesh implantation by me for a free examination.
William F. Barnes, M.D.
Barnes and Ganick Urology
WFB/djm