V249: The use of mesh in Female Pelvic Surgery: An educational video

Video

Introduction and Objectives
The July 13th, 2011 FDA warning statement on surgical mesh used for pelvic organ prolapse and stress incontinence surgery caused much anxiety for patients and for Female Pelvic Surgeons. In this video, our objectives are to show the evolution of prolapse and incontinence repair surgery. This includes showing how prolapse repair incorporating mesh has been used in the past and more recently, and also how the surgical treatment of stress incontinence has evolved to include mesh as the standard of care. We also review the FDA’s warning and what it means for patients contemplating surgery.

Methods
We highlight the progression of Female Pelvic Surgery from abdominal to minimally invasive surgery and the incorporation of surgical mesh. We then demonstrate the evolution of mesh from the initial midurethral slings to the vaginal mesh kits available today in a timeline, and the slings are compared to the vaginal mesh kits. Surgical treatment of pelvic organ prolapse using mesh and non-mesh techniques is then discussed, giving risks and benefits of each option. The FDA warning statement on mesh is then explained to help patients make informed decisions.

Results
The FDA review concluded that transvaginal prolapse repair with mesh does not improve symptomatic results or quality of life when compared to the traditional sutured tissue repair, and mesh used in transvaginal prolapse repair introduces risks not present in traditional non-mesh surgery prolapse repair. They added that abdominal or robotic sacral colpopexy has a lower risk of mesh complication than transvaginal use of mesh in prolapse treatment. The review of the use of mesh for the treatment of stress incontinence is still in progress, with no final recommendations having been made for its use.

Conclusions
We hope that patients watching this video will have a better understanding of the use of mesh in Female Pelvic Surgery, and that this knowledge will help them make informed decisions regarding their surgical treatment.

Funding: none