Amid surgical mesh issues, surgeons are asking

June 22, 2022There is a long history of confusion and controversy regarding the use of polypropylene mesh materials for pelvic floor disorders in women., such as stress urinary incontinence (SUI) or pelvic organ prolapse (POP). So which option would specialist surgeons choose if they had to undergo these procedures themselves? This is the question posed in a survey conducted in Urology practice®a official journal of the American Urological Association (AUA). The journal is published in the Lippincott portfolio by Wolters Kluwer.

According to the report by William J. Devan, MD, of Maine Medical Center, Portland, and colleagues, most surgeons would choose mesh for hypothetical SUI surgery, while treatment choices for POP are mixed. They write, “Overall, we hope the implications of the study findings will help alleviate the negative stigma associated with the global use of mesh.”

Specialists would opt for mesh surgery for SUI – but not transvaginal POP repair

Polypropylene mesh has a long history of use in surgery for pelvic floor disorders, but there is a history of concern about the safety of these materials. Beginning in 2008, the FDA issued a series of alerts warning of rare but potentially serious complications related to the use of meshes to treat SUI and POP. Although these complications can occur in many types of mesh procedures, they most often appear after a transvaginal procedure (surgery performed through the vagina), as opposed to abdominal surgery.

Subsequent data suggested that serious complications are “not uncommon” in women undergoing transvaginal mesh procedures for POP. In 2019, the FDA ordered that mesh products for transvaginal procedures for POPs be permanently removed from the market. Meanwhile, “sling” procedures using mesh materials are considered safe and effective and remain the most common type of surgical treatment for SUI.

Given this long and complex history, what are the opinions of the experts who perform these procedures? Dr. Devan and his colleagues surveyed members of two major specialty societies: the Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU) and the American Urogynecologic Society (AUGS). These experts were presented with a list of options for managing SUI and POP and asked which treatment they would choose if they made the decision themselves.

For SUI, 69% of surgeons said they would opt for a mesh procedure – specifically, a mid-urethral sling procedure using polypropylene mesh. The remaining surgeons said they would choose one of five other options, one of which was “no treatment”. There were some differences of opinion between the different subgroups. For example, surgeons who performed a large number of procedures were more likely to say they would opt for a mid-urethral mesh sling if they were undergoing treatment for SUI.

In contrast, there was no clear single choice for the treatment of POP. Most surgeons said they would opt for conventional abdominal surgery with mesh or vaginal pelvic floor reconstruction using their own native tissues.

Thus, the views of surgical specialists “appear to align” with FDA recommendations supporting the use of mesh for SUI – but against transvaginal mesh for POP. Dr. Devan and his colleagues conclude, “We hope that if patients learned that surgeons performing these operations would opt for mesh when used appropriately, patients might view it more favorably.”

Click here to read “Would surgeons opt for a polypropylene mesh if they had hypothetical stress urinary incontinence or pelvic organ prolapse?”

DOI: 10.1097/UPJ.0000000000000307

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About Urology practice

An official journal of the American Urological Association (AUA), Urology practice focuses on clinical trends, challenges and practical applications in the four areas of business, health policy, specialty and patient care. Information that can be used in daily practice will be provided to the urological community via peer-reviewed clinical practice articles (including best practices, reviews, clinical guidelines, selected clinical trials, editorials and books white papers), “research letters” (short original studies with an important clinical message), the affairs of urology practice, health policy issues in urology, education and training in urology, as well as content for members of the urology care team.

About the American Urological Association

Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is one of the leading advocates for the specialty of urology and has more than 23,000 members worldwide. The AAU is a leading urological association, providing invaluable support to the urological community in pursuit of its mission to foster the highest standards of urological care through education, research and formulation of health care policy. health. To learn more about the AAU, visit: www.auanet.org

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Christine E. Phillips