Medicolegal basics and update on transvaginal mesh in Canada

Hengel, Brock; Welk, Blayne; Baverstock, Richard

doi:10.5489/cuaj.4580

Cited by 3 publications

(2 citation statements)

References 4 publications

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“…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]. The culmination in the Cumberlege report and the subsequent formation of the recommended nine national complex mesh centres, who's focus is holistically managing women with continence and prolapse mesh complications, firmly establishes the place of mesh removal surgery in clinical practice.…”

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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“…If mesh-based procedures are being considered, the current advisories and position statements regarding mesh should be discussed and made available. 61 See online Appendix for additional discussion on this question.…”

Section: What Are the Key Elements To Include In Obtaining Informed C...mentioning

confidence: 99%

2024 Canadian Urological Association guideline: Female stress urinary incontinence

Carlson,

Andrews,

Bascom

et al. 2024

CUAJ

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prior to publication, this guideline underwent review by the cua guidelines steering committee and expert reviewers. INTRODUCTION & PURPOSEFemale stress urinary incontinence (FSUI) is a common condition that affects approximately 10-20% of the population. 1 It is associated with negative impacts on quality of life (QoL), socialization, and exercise; it has a significant financial impact, and is associated with depression and anxiety. 2 In 2012, the last Canadian Urological Association (CUA) guideline addressing adult urinary incontinence was published; it covered male and female nonneurogenic stress and urgency incontinence. 3 Given the considerable changes in the management of FSUI, and the very distinct considerations and surgical procedures for this group, an individual guideline providing a more detailed overview of this topic was requested by the CUA Guidelines Steering Committee.The specific population this guideline is intended to cover is women over 18 years of age with stress urinary incontinence. This CUA guideline is intended to be used by healthcare providers treating patients with FSUI. The guideline objective is to cover topics important to the evaluation, counselling, non-surgical and surgical treatment of FSUI, and the management of complications of FSUI surgery.Given the significant variation in patients with FSUI, in some sections we focus on the evaluation and management of the "index patient" (similar to other guidelines). 4,5 Other sections are dedicated to specific nonindex patients with FSUI. We recognize that guidelines cannot address the management of all FSUI scenarios. METHODOLOGYWe decided to use a question-and-answer format to provide brief, accessible, and practical answers to common questions addressing the evaluation and management of FSUI. The guideline panel was created to provide representation from a mix of community and academic urologists and allied health professionals from across Canada, in keeping with the CUA guideline rules. Disagreements during the guideline process were resolved by consensus-building. Conflicts of interests for the authors are included at the end of the guideline. The views or interests of the CUA did not influence the final set of recommendations.The guideline panel was led by Dr. Kevin Carlson and Dr. Blayne Welk. The group first met virtually in December 2021. Objectives to guide the development of this document were agreed upon: 1) to be comprehensive without replicating existing evidence reviews; 2) to provide evidence-based and expert-based opinions on relevant topics within FSUI; and 3) to address the unique needs of Canadian urologists where appropriate.All guideline members were asked to submit relevant topics that could be addressed in a questionand-answer format, and the final list of questions was agreed upon by the panel. Further feedback was received from CUA members at the 2022 CUA annual meeting. Individual sections were assigned to members, with another panel member acting as primary reviewer. Members reviewed publications relevant to ...

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Mesh-associated pain syndrome: predictors for continence and prolapse mesh removal surgery in a single centre

Elneil,

Delanerolle,

Zeng

et al. 2024

BMC Women's Health

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Objective Over the last two decades one of 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 evaluation. Setting 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.

show abstract

Medicolegal basics and update on transvaginal mesh in Canada

Cited by 3 publications

References 4 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

2024 Canadian Urological Association guideline: Female stress urinary incontinence

Mesh-associated pain syndrome: predictors for continence and prolapse mesh removal surgery in a single centre

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