Do guns kill people or...? The mesh dilemma

Butrick, Charles W.

doi:10.1007/s00192-009-1082-8

Cited by 7 publications

(4 citation statements)

References 5 publications

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“…Finally, the coexistence of POP and additional pelvic floor disorders (rather than a purely causal relationship) should be considered before undertaking corrective surgery. A recent editorial proposed that preoperative pelvic pain may be associated with significant hypertonic pelvic floor musculature and/or pain of myofascial origin, and should be strongly suspected in the absence of POP at the introitus or beyond [97]. As such, the author suggested, the anchoring of mesh to musculature that is already hypertonic and spastic may perpetuate and exacerbate preoperative dyspareunia.…”

Section: The Questions: What We Do Not Know About Mesh (Yet)mentioning

confidence: 99%

Pelvic organ prolapse (POP) surgery: the evidence for the repairs

2011

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What is known on the subject? and What does the study add? Substantial experience of the outcomes has been gathered regarding the acute and sub‐acute experience with various types of corrective procedures for POP. These include long‐term POP correction as well as more recent recognition of improvement in functional disorders associated with POP such as UI, colorectal dysfunction, and sexual dysfunction. Long‐term follow‐up is available for some of the older types of interventions and current multicentre trials are being accrued with longer term follow‐up for new interventions including mesh‐type repairs. The study adds a condensed and summarized version of the current literature regarding the various interventions for POP and also provides an overview of the current controversies and areas where knowledge is incomplete and in need of further elaboration for definitive answers regarding optimization of surgical care for POP. • Our aim is to summarise the available data on the transvaginal placement of synthetic mesh for pelvic organ prolapse (POP) repair, with a focus on the outcomes and complications of commercial POP‐repair kits. • As the stability and durability of autologous tissues may be questionable, nonabsorbable, synthetic materials are an attractive alternative for providing additional support during POP surgery. These materials are not novel, and most have been used for many years in surgical applications, e.g. hernia repairs. • While theoretically appealing, the implantation of synthetic mesh in the pelvis may be associated with inherent adverse consequences, such as erosion, extrusion, and infection. Additionally, the routine use of these materials may carry potential long‐term complications, such as dyspareunia, chronic pelvic pain, and vaginal distortion. • The success and failure of mesh‐augmented POP repair is related not only to the synthetic material itself, but also to patient‐ and surgeon‐related factors. • Recent warnings by the USA Food and Drug Administration and other groups regarding adverse events further complicate the decision to use synthetic mesh.

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Section: The Questions: What We Do Not Know About Mesh (Yet)mentioning

confidence: 99%

Pelvic organ prolapse (POP) surgery: the evidence for the repairs

2011

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“…The degree of response depends on the nature and structure of the material (synthetic or biological) used as well as on the amount and volume implanted [45,46]. Some evidence suggests that attachment of the graft to the pelvic floor muscle instead of to the ligaments could influence the outcome of the procedure and possibly increase dyspareunia after surgery [47]. In response to increasing complication rates related to the use of vaginal mesh in pelvic floor reconstruction surgery, the United States Food and Drug Administration has issued a statement and warning pertaining to the use of vaginal mesh [48].…”

Section: Popmentioning

confidence: 99%

“…The average prevalence of de novo dyspareunia after any type of repair can be as high as 15% if the repair is done vaginally and slightly less if done abdominally. Special attention should be paid to patient selection, especially for those who have conditions suggestive of pelvic floor dysfunction (pelvic floor muscle spasm/trigger points, interstitial cystitis, vulvodynia, chronic constipation, obstructive LUTS) before surgery, because these patients tend to experience more complications and less satisfaction after repair [47].…”

Section: Popmentioning

confidence: 99%

Continuing Medical Education: Urogenital Complaints and Female Sexual Dysfunction (Part 2) (CME)

Wehbe

Kellogg

Whitmore

2010

The Journal of Sexual Medicine

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Introduction Female sexual dysfunction (FSD) is common in women with urogenital disorders that occur as a result of pelvic floor muscle and fascial laxity. Aim Provide a comprehensive review of FSD as it relates to common urogenital disorders including pelvic organ prolapse (POP) and stress urinary incontinence (SUI) and to discuss the impact of the surgical repair of these disorders on sexual function. Methods Systematic search of the medical literature using a number of related terms including FSD, POP, SUI, surgical repair, graft augmentation, complications, and dyspareunia. Main Outcome Measures Review of the medical literature to identify the relation between FSD and common urogenital disorders in women and to describe appropriate treatment strategies to improve quality of life (QOL) and sexual function. Results FSD is common in women with POP and SUI. Treatment options for POP and SUI include behavioral, pharmacological, and surgical methods which can also affect sexual function. Conclusions Sexual dysfunction is a common, underestimated complaint in women with POP and SUI. Treatment should be tailored toward improving sexual function and QOL. Surgical correction is generally beneficial but occasionally can result in negative alterations in sexual function. Patient selection and methods used for surgical repair are important factors in determining anatomical and functional success.

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“…At the time this trial was designed, in 2007, no randomised studies had been published comparing anterior colporrhaphy with the trocar‐guided transobturator mesh procedure. Observational studies showed the use of mesh to be anatomically effective; however, there were concerns about the risk of complications such as exposure of the mesh or the occurrence of de novo dyspareunia 8–11 . Despite the lack of proper scientific evidence, this new transobturator mesh technique was rapidly adopted in many countries.…”

Section: Introductionmentioning

confidence: 99%

Primary surgical repair of anterior vaginal prolapse: a randomised trial comparing anatomical and functional outcome between anterior colporrhaphy and trocar‐guided transobturator anterior mesh

Vollebregt

Fischer

Gietelink

et al. 2011

BJOG

127

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Objective To compare anterior colporrhaphy with a trocar-guided transobturator mesh procedure (Avaulta Ò anterior).Design Randomised, controlled trial.Setting Three teaching hospitals.Population Women with a symptomatic cystocele at least stage II requiring primary surgical correction.Methods A total of 125 women were assessed at baseline and 1-year follow up. A sacrospinous hysteropexy or posterior colporrhaphy was performed when indicated.Main outcome measures The primary outcome was the difference in anatomical cure (defined as Pelvic Organ ProlapseQuantification

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Do guns kill people or...? The mesh dilemma

Cited by 7 publications

References 5 publications

Pelvic organ prolapse (POP) surgery: the evidence for the repairs

Pelvic organ prolapse (POP) surgery: the evidence for the repairs

Continuing Medical Education: Urogenital Complaints and Female Sexual Dysfunction (Part 2) (CME)

Primary surgical repair of anterior vaginal prolapse: a randomised trial comparing anatomical and functional outcome between anterior colporrhaphy and trocar‐guided transobturator anterior mesh

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