MND checked in to see if the current thinking of AUGS regarding the use of polypropylene transvaginal mesh medical devices has evolved over the years since more reports of injury are reaching the mainstream medicine and there are approximately 150,000 defective lawsuits facing the mesh manufacturers in the U.S. alone.
This is a 4 minute read but important information to know for anyone who has a discussion about a mesh implant with her doctor.
MND has a request in to do a Q and A with the current president of AUGS. He prefers your editor send in written questions which is underway.
CONTEXT: Since 2012, mesh injuries in the U.S. consolidated into more than 104,000 product liability cases filed in one federal court including injuries ranging from mesh-in-place, to life-altering severe complications, to death. Increasingly, experts at trial are blaming polypropylene as an unstable product in the body which shrinks, leads to scar plate formation that encases nerves and hosts antibiotic resistant infections. Chronic pain and infection result with little remedy other than medication.
POP mesh, generally larger to cover the pelvic floor and support sagging organs, has been reclassified as highest risk by the FDA, Class III but manufacturers were given 30 months to remove it from the market OR prove safety and efficacy via clinical trials. AUGS indicates it is still being used, which will merit further questions.
Some doctors have changed their association with mesh. For example, former mesh user, Dr. Shlomo Raz (here) of UCLA, has reversed his thinking and now will not use PP mesh because he is seeing complications a decade later.
The SUI / AUGS Position Statements:
The POP/ AUGS Position Statements:
In the OR, Source: The Doctors
CONTEXT: Discovery from trial has shown that Johnson & Johnson, for example, trained a doctors with a range of skills, not all up to the task of learning this blind procedure and assuring patient safety.
J&J discovery has shown that lower tier doctors were not learning as fast as top tier doctors (here). Often doctors blame mesh injuries on less experienced surgeons. The fact is that weekend cadaver clinics have, in some cases, sufficed for clinical surgical training.
AUGS feels that mesh should be placed by providers who:
CONTEXT: Many women who MND has interviewed wish they had had received true informed consent so that they would have known the full range of possible outcomes and complications from their mesh implant.
See MND ,What you should ask your surgeon (here).
Alternative surgeries are available and always have been including a Burch procedure (sutures) or using one's own ligaments to fashion a sling, as an alternative to a polypropylene implant. Many readers state they wish they had known enough to ask for those alternatives first.
AUGS says, "First line treatment should always consist of nonsurgical approaches, including behavioral and physical therapy. For patients who do not find relief from nonsurgical options, there are multiple surgical options.
"AUGS continues to feel that women are better served when their preferences and values are honored through a range of treatment options for SUI and POP, including the option for transvaginally placed polypropylene mesh when appropriate."
CONTEXT: When the U.S. Food and Drug Administration reclassified the larger polypropylene mesh used for pelvic organ prolapse into Class III, highest risk, it gave industry 30 months to remove it from the market OR show it is safe and effective through clinical trials. POP mesh otherwise must go through a higher level of FDA scrutiny, specifically premarket approval (PMA) before it can be sold.
See MND story here.
AUGS says, "This is not the case in the U.S."
This answer does not completely put into context the fact that POP mesh is supposed to have undergone a PMA or clinical trials before it is marketed, therefore leaving few choices for POP mesh still one the market MND will follow up.
CONTEXT: Since mesh implants and corresponding problems have been noted, at least anecdotally, since the late 90's. MND wonders what, if anything, is the take away lesson.
AUGS answers, "Medicine in general is always seeking to improve itself, as the status quo is often suboptimal. New technologies often provide answers to some questions, while bringing up new ones.
"Understanding the details of the relative benefits and risks for the individual patient in front of you is the goal of the physician; it is unlikely that new technologies are the right answer for every patient, but it is also the case that having an array of options to learn about and choose from is an advantage for every patient. The key is to have a clear understanding of the benefits and potential risks of new technologies before they are marketed, and that is the role of research.
"As the leader in Female Pelvic Floor Medicine and Reconstructive Surgery, AUGS strives to provide a culture of practice where new technologies can be introduced, evaluated, and deployed, and continuously re-evaluated, in an evidence-based and systematic manner."
CONTEXT: There is no doubt that, anecdotally, the incidents of chronic infection is observed in the mesh injured population. Without following up and studying these complications, there is no way to understand whether the polypropylene is a host or biofilms, infection, or foreign body reaction is causing the body to go on high alert sparking autoimmune reaction.
AUGS says, "There is good population-based science that there is no association between polypropylene mesh pelvic implantation and development of cancer. There is also good science that shows some features of implants (density, pore size, architecture) may reduce undesired reactions in vivo. There is no compelling data suggesting that there is a statistically realistic relationship between mesh implantation and systemic autoimmune responses.
Relevant Research includes:
MND, AUGS Breaks with the Father of Gynecology, July 4, 2018
At the annual meeting of the American Association of Gynecologic Laparoscopists (AAGL), two leading urogynecologists debated the use of pelvic mesh versus native tissue repair in surgery.
In this Mesh News Desk podcast, Dr. Donald Ostergard talks about how to find a doctor to do pure tissue repair rather than use polypropylene mesh, tests, and treatments for SUI.
Why have hernia surgeries with mesh become the most common repair for 95 percent of procedures? Dr. William Brown weighs in on this Hernia Mesh Insights podcast.