What treatment would you choose for yourself?

Newswise – 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 incontinence (SUI) or pelvic organ prolapse (POP). So what option would specialist surgeons choose if they were to undergo these procedures themselves? This is the question asked in a survey in Urology practice®which is the official journal of American Urological Association (AUA). The magazine is published in Lippincott Portfolio by Walters Kluwer.

Most surgeons will choose a mesh for a hypothetical SUI surgery, while treatment options for POP are mixed, according to William J. Devan, MD, of Maine Medical Center, Portland, and colleagues. They write, “Overall, we hope that the implications of the study results will help reduce the negative stigma associated with network use in general.”

Specialists will choose retinal surgery for SUI – but not transvaginal POP repair

Polypropylene mesh has long been used in surgery for pelvic floor disorders, but there is a history of concerns about the safety of this material. Beginning in 2008, the FDA issued a series of alerts warning of rare but serious complications associated with the use of the net to treat SUI and POP. Although this complication can occur with many types of mesh operations, it is more commonly seen after vaginal surgery (surgery performed through the vagina), as opposed to abdominal surgery.

Subsequent data indicated that serious complications were “not rare” in women who undergo transvaginal network POP procedures. In 2019, the US Food and Drug Administration (FDA) required that mesh products for POP vaginal procedures be permanently removed from the market. Meanwhile, “lift” procedures using mesh materials are safe and effective, and are still the most common type of surgical treatment for SUI.

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

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

In contrast, there was no single clear POP treatment option. Most surgeons said they would opt for traditional abdominal surgery with retinal or vaginal pelvic floor reconstruction using their own original tissue.

Thus the surgeon’s opinions appear to be “in line” with the FDA’s recommendations supporting the use of the mesh in SUI – but against the transvaginal mesh for POP. Dr. Devan and colleagues conclude, “We hope that if patients know that the surgeons performing these procedures will select the mesh when used appropriately, patients may view it better.”

Click here to read “Will Surgeons Choose Polypropylene Mesh If They Presumptively Suffer From Stress Incontinence or Pelvic Organ Prolapse?”

doi: 10.1097/UPJ.0000000000000307

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Around Urology practice

Official Gazette of American Urological Association (AUA), Urology practice It focuses on trends, challenges, and clinical practice applications in the four areas of business, health policy, specialty, and patient care. Information that can be used in the daily practice of the urological community will be made available via peer-reviewed clinical practice articles (including best practices, reviews, clinical guidelines, selected clinical trials, editorials, and white papers) and ‘research letters’ (summary original studies with important clinical message) Urology practice work, urology health policy issues, urology education and training, as well as content for members of the urology care team.

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Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is a leading advocate for the specialty of urology, with more than 23,000 members worldwide. AUA is a leading urological association, providing invaluable support to the urological community as it pursues its mission to promote the highest standards of urological care through education, research, and health care policy formulation. To learn more about visiting AUA: www.auanet.org

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