Vaginal Mesh Commercials

How about all those vaginal mesh commercials! If folks are like me it is painful to view all the “call us, you may be entitled to financial compensation” commercials. A number of years ago I determined that the time to retire would be marked by a class action law suit commercial with focus on Tylenol. Well Tylenol has been implicated and I am not old enough to retire. frown emoticon Being a physician/surgeon and having yet achieved perfection in my professional or personal life these are even more disheartening particularly when focusing on any work with which I am involved.

Many may have questions about the mesh products used for prolapse and incontinence. A little historical perspective may be helpful, something I share with those who suffer from this problem and struggle to know what to do.

Back in the day when I was in training observing my mentors counseling their patients I routinely heard the following: “We will go ahead and get this corrected for you, but I don’t want you to be surprised at all if at a future date we have to do this again because everything comes done again.” I thought, “Why can’t we fix this problem so it does not fail?”

Some of the doctors back then suggested that the failure rate was in the 40-50% range. Almost the flip of a coin if a person would have a long term success. The successful use of mesh for hernia surgery lead to doctors using mesh for vaginal prolapse and seemed to be the answer to longevity although not perfect either. The best part of using mesh is also the worst part of using mesh, it is designed to be permanent. If supporting well it is there for good, if having a problem such as an erosion it is there for good and requires additional work to remove or revise. That rate is around 7% according to the manufacturer of the mesh I use.

So what does the patient and the doctor counseling them do with this information. If we revert back to the classic repairs we accept a large failure rate & need for additional surgery. If using the mesh we have to accept the erosion rate and need for surgery along with the feeling on the part of the doctor that he may be stepping in front of the red laser sight of litigation. Difficult challenges for sure so it merits good information and patients making their best decisions given that parts falling out or an inability to control the bladder are not life threatening conditions.

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