Counseling for stress urinary incontinence in the era of adverse publicity around mesh usage: Results from a large‐sample global survey

Zilberlicht, Ariel; Karmakar, Debjyoti; Dwyer, Peter; Chan, Garson; Schierlitz, Lore

doi:10.1002/ijgo.14418

Cited by 4 publications

(4 citation statements)

References 24 publications

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“…Several factors may have led to this including: the rulings by the FDA in 2011 banning mesh in the United States; the ruling by the MHRA in the UK in 2011 and 2012 raising awareness on the debilitating complications of the mesh; and the reports from the National Institute for Clinical Excellence between 2007 and 2017, where caution was urged in the use of mesh and a focus for more research was encouraged. But, perhaps it was the rise in public awareness led by women affected by the complications of mesh along with the national media that changed the emphasis from mesh insertion and its benefits, to that of mesh complications and the need for surgical removal [39,40]. Unsurprisingly, this was mirrored in the rise of both medico-legal claims against implanting surgeons, device firms and institutions of practice [41].…”

Section: Discussionmentioning

confidence: 99%

Mesh-Associated Pain Syndrome: Predictors for Continence and Prolapse Mesh Removal Surgery in a Single Centre

Elneil,

Delanerolle,

Zeng

et al. 2023

Preprint

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Objective:Over the last two decades the main surgical treatment for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) surgery was the insertion of non-absorbable mesh to restore continence and prolapse respectively. Over time complications arose including mesh-associated pain syndrome (MAPS), mesh exposure, mesh-erosion, chronic bladder/vaginal infections, and dyspareunia. Consequently, women chose surgical mesh removal to counter these problems. However, little is known about the demographics, medical co-morbidities, mesh types involved and the timing from mesh insertion to mesh removal. This retrospective study will look at which of these factors may be closely associated with mesh removal surgery.Design:Retrospective studySetting:Female Pelvic Medicine and Reconstructive Surgery (FPMRS) Clinic at University College London Hospitals NHS Foundation Trust.Population:All patients presenting to the FPMRS Clinic between June 2011 to December 2019, requesting mesh removal surgery with a history of MAPS and other mesh complications were included in this study. Methods:Patient demographics including age, ethnicity, obstetric history, and medical co-morbidities; type of mesh/anatomical route used; onset of symptoms; and time from insertion to removal were recorded. Main Outcome Measures:Determination of correlation coefficients between patient demographics, patient reported symptoms and mesh removal surgery. Results:Three hundred and forty-five women with a history of MAPS were included in the study. Women in the 40-60 year old cohort accounted for 54.4% of mesh removal surgery; 54.8% had a BMI under 30 and almost 90% were Caucasian. 96.5% had had children, with over 77% having had a vaginal delivery. 91.9% of patients reported other health conditions including 18.8% with a concomitant history of mental health problems and 15.4% with a history of heart disease. Over 80% of women undergoing mesh removal surgery had a continence mesh (49% retropubic and 32% obturator continence mesh) removed, whereas 20% had an abdominal prolapse and/or vaginal prolapse mesh removed. The average time from mesh insertion to mesh removal was seven years, with the prevalence of mesh removal surgery averaging 85% (range 50 - 100%) depending on the comorbidity determined. Conclusions:All women presented to the clinic with a history of MAPS and other comorbidities which may have influenced their decision to pursue mesh removal surgery. There were no specific predictors, other than chronic pain associated with mesh, determining which women underwent surgery, though those with continence mesh were more likely to do so.

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Section: Discussionmentioning

confidence: 99%

Mesh-Associated Pain Syndrome: Predictors for Continence and Prolapse Mesh Removal Surgery in a Single Centre

Elneil,

Delanerolle,

Zeng

et al. 2023

Preprint

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“…2021 position statement that "Polypropylene mesh slings are the standard of care for the surgical treatment of SUI." 3,4 Patient hesitation is likely related to recovery restrictions, potential complications with mesh usage, as well ambivalence toward surgery for a non-life-threatening condition. 5 Recently updated American Urological Association guidelines revised promoting MUS as first-line surgical treatment stating, "patients should be offered all viable options for treatment of their stress incontinence, with a discussion that includes detailed counseling regarding the risks, benefits, alternatives to each approach, and the safety and efficacy profiles of the various choices."…”

Section: Why This Mattersmentioning

confidence: 99%

“…The midurethral sling (MUS) offers an outpatient procedure to treat SUI with high efficacy, low complication rates, and fast recovery times. This practice is supported by organizations such the American Urogynecologic Society and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction who wrote in a 2021 position statement that “Polypropylene mesh slings are the standard of care for the surgical treatment of SUI.” 3,4 Patient hesitation is likely related to recovery restrictions, potential complications with mesh usage, as well ambivalence toward surgery for a non–life-threatening condition 5 . Recently updated American Urological Association guidelines revised promoting MUS as first-line surgical treatment stating, “patients should be offered all viable options for treatment of their stress incontinence, with a discussion that includes detailed counseling regarding the risks, benefits, alternatives to each approach, and the safety and efficacy profiles of the various choices.” 6 …”

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confidence: 99%

Reconstruction of Urethral Sphincter With Polyacrylamide Hydrogel

Clearwater,

Panushka,

Najor

et al. 2024

UROGC

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Importance Urethral bulking is an alternative to synthetic midurethral sling for the treatment of stress urinary incontinence (SUI) in women. Urethral bulking agents, which are injected in the submucosal tissues of the proximal urethra/bladder neck, have demonstrated less adverse effects with similar satisfaction rates but lower subjective and objective cure rates when compared with midurethral sling. Cystoscopic Reconstruction of External Sphincter Technique (CREST) is a novel technique, which reinforces the natural closure mechanism of the external urinary sphincter (EUS). Objective The aim of the study was to provide safety and efficacy data for injecting polyacrylamide hydrogel (PAHG) in the components of the female EUS. Study Design This was a retrospective chart review of patients using CREST with PAHG as initial treatment for SUI by a single surgeon from January 2022 to October 2022. Exclusion criteria are as follows: younger than 18 years, prior SUI surgery, concomitant pelvic organ prolapse or reconstructive procedure, neurological conditions, or history of radiation. Subjective and objective cure rates were measured by patient-reported symptoms and cough stress test. Urinary retention, postoperative urinary infection, and de novo urinary urgency were assessed. Results One hundred and thirteen consecutive patients met inclusion criteria with median follow-up of 3 months. Eighty-five percent of participants reported subjective improvement, 69% reported subjective cure, and 69% demonstrated objective cure. Nine patients reported transient postoperative retention, 8 reported postoperative urinary tract infections, and 5 reported de novo urgency. There were no serious adverse events. Conclusions CREST is a novel technique for injection of PAHG, into the EUS to treat SUI. Our data suggest that this technique could improve urethral injection outcomes with minimal complications.

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“…Data from the National Health Service (NHS) in England between 2012 and 2018 showed a decrease in mid-urethral sling surgery and an increase in bulking procedures [ 18 ]. An electronic survey of the members of the International Urogynecological Association (IUGA) and the American Urogynecologic Society (AUGS) showed that retropubic mid-urethral slings were the preferred initial surgical treatment for SUI (62%), whereas bulking agents were only preferred by 5% of the survey responders [ 52 ]. Another survey among healthcare professionals in England showed that using mid-urethral slings for treating SUI was still the most popular choice before and after informing of specific complications [ 53 ].…”

Section: Bulking Agents To Treat Suimentioning

confidence: 99%

Current Treatment of Stress Urinary Incontinence by Bulking Agents and Laser Therapy—An Update

Sikora,

Gamper,

Zivanovic

et al. 2024

JCM

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Stress urinary incontinence (SUI) affects around 20% of women. In addition to the established suburethral sling insertion, two less invasive approaches are of interest today: urethral bulking agents and vaginal laser therapy. This review discusses articles through December 2023 identified by a PubMed literature search using the keywords “incontinence” and “bulking” or “laser”. Although the two approaches are less effective than sling insertions, there are specific conditions in which one or the other technique is more advantageous. Injecting bulking agents into the urethra only takes some minutes and works without general anesthesia. The method is particularly suited for elderly, frail, or obese patients with multiple comorbidities, but is also applicable for all patients and in combination with other therapies. Generally, the safety profile is good but differs between bulking materials. Two laser types—the Erbium:YAG laser with SMOOTH-mode and the fractional ablative CO2 laser—deliver heat into the tissue to induce tissue tightening and regeneration. Intravaginal laser therapy improves mild to moderate SUI, while studies describe how intraurethral laser therapy is also beneficial for severe SUI. Young women between childbirths, as well as postmenopausal women, may benefit from laser therapy. The method is safe, can be performed on an outpatient basis, and does not require any artificial material.

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Counseling for stress urinary incontinence in the era of adverse publicity around mesh usage: Results from a large‐sample global survey

Cited by 4 publications

References 24 publications

Mesh-Associated Pain Syndrome: Predictors for Continence and Prolapse Mesh Removal Surgery in a Single Centre

Mesh-Associated Pain Syndrome: Predictors for Continence and Prolapse Mesh Removal Surgery in a Single Centre

Reconstruction of Urethral Sphincter With Polyacrylamide Hydrogel

Current Treatment of Stress Urinary Incontinence by Bulking Agents and Laser Therapy—An Update

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