Pain Related to Transvaginal Mesh Placed for Stress Urinary Incontinence and Pelvic Organ Prolapse

2017 ◽  
pp. 145-154
Author(s):  
Ashley B. King ◽  
Howard B. Goldman
Keyword(s):  
Urinary Incontinence ◽  
Pelvic Organ Prolapse ◽  
Stress Urinary Incontinence ◽  
Pelvic Organ ◽  
Transvaginal Mesh

scholarly journals The mesh controversy

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 2423 ◽  
Author(s):  
Joshua A. Cohn ◽  
Elizabeth Timbrook Brown ◽  
Casey G. Kowalik ◽  
Melissa R. Kaufman ◽  
Roger R. Dmochowski ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Pelvic Organ Prolapse ◽  
Stress Urinary Incontinence ◽  
Pelvic Organ ◽  
Transvaginal Mesh ◽  
Class Iii ◽  
Regulatory Oversight ◽  
Mesh Placement ◽  
Recent Developments ◽  
Uncertain Future

Pelvic organ prolapse and stress urinary incontinence are common conditions for which approximately 11% of women will undergo surgical intervention in their lifetime. The use of vaginal mesh for pelvic organ prolapse and stress urinary incontinence rose rapidly in the early 2000s as over 100 mesh products were introduced into the clinical armamentarium with little regulatory oversight for their use. US Food and Drug Administration Public Health Notifications in 2008 and 2011, as well as reclassification of transvaginal mesh for prolapse to class III in early 2016, were a response to debilitating complications associated with transvaginal mesh placement in many women. The midurethral sling has not been subject to the same reclassification and continues to be endorsed as the “gold standard” for surgical management of stress urinary incontinence by subspecialty societies. However, litigators have not differentiated between mesh for prolapse and mesh for incontinence. As such, all mesh, including that placed for stress urinary incontinence, faces continued controversy amidst an uncertain future. In this article, we review the background of the mesh controversy, recent developments, and the anticipated role of mesh in surgery for prolapse and stress urinary incontinence going forward.

scholarly journals Clinical Outcomes and Urodynamic Effects of Tailored Transvaginal Mesh Surgery for Pelvic Organ Prolapse

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Ting-Chen Chang ◽  
Sheng-Mou Hsiao ◽  
Chi-Hau Chen ◽  
Wen-Yih Wu ◽  
Ho-Hsiung Lin
Keyword(s):  
Quality Of Life ◽  
Urinary Incontinence ◽  
Pelvic Organ Prolapse ◽  
Stress Urinary Incontinence ◽  
Clinical Outcomes ◽  
Positive Impact ◽  
Pelvic Organ ◽  
Transvaginal Mesh ◽  
Mesh Surgery

Objective. To evaluate the clinical outcomes and urodynamic effects of tailored anterior transvaginal mesh surgery (ATVM) and tailored posterior transvaginal mesh surgery (PTVM).Methods. We developed ATVM for the simultaneous correction of cystocele and stress urinary incontinence and PTVM for the simultaneous correction of enterocoele, uterine prolapse, vaginal stump prolapse, and rectocele.Results. A total of 104 women enrolled. The median postsurgical follow-up was 25.5 months. The anatomic cure rate was 98.1% (102/104). Fifty-eight patients underwent urodynamic studies before and after surgeries. The pad weight decreased from 29.3 ± 43.1 to 6.4 ± 20.9 g at 3 months. Among the 20 patients with ATVM, 13 patients had objective stress urinary incontinence (SUI) at baseline while 8 patients came to have no demonstrated SUI (NDSUI), and 2 improved after surgery. Among the 38 patients who underwent ATVM and PTVM, 24 had objective SUI at baseline while 18 came to have NDSUI, and 2 improved after surgery. Mesh extrusion (n= 4), vaginal hematoma (n= 3), and voiding difficulty (n= 2) were noted postoperatively. Quality of life was substantially improved.Conclusions. Our findings document the advantages of these two novel pelvic reconstructive surgeries for pelvic organ prolapse, which had a positive impact on quality of life. ATVM surgery additionally provided an anti-incontinence effect. This clinical trial is registered at ClinicalTrials.gov (NCT02178735).

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