Dr. Veronikis: What is Informed Consent Concerning Transvaginal Mesh Removal?
Mesh News Desk (MND) interviewed Dr. Dionysios Veronikis of the Vaginal Surgery and Urogynecology Institute of St. Louis.
Dr. Veronikis was brought to our attention by the large number of women referred to his practice for transvaginal mesh removal after suffering the complications of transvaginal mesh implants for both stress urinary incontinence and pelvic organ prolapse. At the present time about half of his practice involves mesh removals (explants) and he tells MND he performs about 350 removals of both slings and mesh kits a year among his 700 surgical procedures.
He is board certified in female pelvic medicine and reconstructive surgery. Dr. Veronikis did his residency at Bay State Medical Center in Massachusetts and a Fellowship at Mass General Harvard Medical School in Boston. He is board certified and fellowship trained in female pelvic medicine and reconstructive surgery.
He still opts to use synthetic mesh under certain circumstances but prefers to harvest fascia from a woman’s own body. Dr. Veronikis’ profile will follow but here are his suggestions for having a productive conversation with your doctor if you are considering pelvic reconstructive surgery to treat incontinence, prolapse or removal surgery of mesh treatment devices.
A profile of Dr. Veronikis does not imply an endorsement by Mesh News Desk and any woman should consult with a variety of doctors before making a decision about this important procedure. Mesh News Desk or Jane Akre, editor were not compensated in exchange for this content.
Q: What should a woman ask to have true informed consent?
“First of all she shouldn’t go to anyone whose practice is not dedicated to gynecologic reconstructive surgery. It’s like having a high risk pregnancy and being treated by your family practitioner who did one month of obstetrics 20 years ago. You should go to someone boarded in female pelvic medicine and someone who has gone to a fellowship, in other words, fellowship trained and boarded.”
Ask the doctor:
- How much of this do you do? You want someone whose practice is solely focused on reconstructive surgery.
- What are your outcomes?
- What are you complications? That person should be frank transparent in what he or she does because no one walks on water.
- The next question should be – So I understand to do reconstructive surgery you need to use to suspend fix to isolate, what are my options? He will say we can use your own body which is maximally invasive now because I have to make incisions for harvesting and leave a defect at the harvest site.
- What are my personal outcomes? We can use an animal – bovine or porcine that makes it less invasive because we’re not cutting on your body to harvest a sling. The third the option is mesh.
- Ask to delineate outcomes – What the operating room times will be? What are the potential complications? What should the post-operative convalescence be?
- If it was your mother or sister what would you recommend in my case? The surgeon should say if you have a sedentary life, you will probably have a good outcome either with your own body or biologic mesh. But if you are prone to blood clots we need to cut down the operating room times as it can take 1.5 hr to harvest fascia only, depending on what we are harvesting. In order to cut down on the time we may want to use cadaveric, porcine or bovine materials.
If you are prone to asthma attacks, if you pick up heavy things for a living, if I use anything but an implant it may fail. That’s okay if we are partners in it. Even the synthetic may fail. In the literature there is a higher rate of erosion but in my hands it’s negligible. What I can’t tell you about are the effects on your immune system.
Finally I tell them I will always take care to you. I will not dismiss your symptoms, if you are having a problem. I am your surgeon.
Images available from Vaginal Surgery and Urogynecology Institute of St. Louis (Warning many images and videos are graphic!)
Vaginal Surgery and Urogynecology Institute of St. Louis http://vaginalsurgeryandurogynecologyinstitute.com/