Two Studies on Mesh Offer Questionable Outcomes of Success

Jane Akre
September 20, 2011

Two Published Studies - Consider Your Odds

SEPTEMBER 20, 2011- Two studies on the use of synthetic mesh for female stress urinary incontinence treatment offer a couple of different outcomes. The first one in the Journal of Minimally Invasive Gynecology published August 19, 2011 comes out of Tel Aviv University’s Department of Obstetrics and Gynecology. See it here.

Ten-Year Subjective Outcome Results of the Retropubic Tension-Free Vaginal Tape for Treatment of Stress Urinary Incontinence

The objective was to follow-up on a small number of women 10 years after they had retropubic tension-free vaginal tape also known as TVT (placed through the vagina) mesh implanted.

A group of 60 women who underwent surgery in 2000 with a mean age of 62.4 were called and asked questions about the success or not of their procedure. Eighty-seven percent of the women were available. Among the outcomes:

*54% had concomitant urge urinary incontinence (stress and urge incontinence)

*65% considered their condition cured

*12% believe their condition was improved

*23% thought the surgery had failed

*21% had stress urinary incontinence

*42% had urge urinary incontinence

*15% had recurrent urinary tract infections

*4% underwent repeated TVT surgery

The ABSTRACT says in conclusion:

“Ten-year subjective outcome of retropubic TVT are less favorable than previously reported. Early postoperative impaired bladder emptying is the most significant risk factor for long-term failure.”

Full article available by purchase only here.

In the second study:

Prophylactic Use of Mesh to Prevent SUI Before it Starts

A woman doesn’t have stress urinary incontinence so why have a treatment implanted? Why not treat SUI before it starts a researcher told colleagues at the American Urogynecologic Society (AUGS) meeting in Providence, Rhode Island September 19.

Dr. John T. Wei, professor of medicine at the University of Michigan in Ann Arbor said a mid-urethral sling is use prophylactically (placed to prevent something, just in case) in women undergoing vaginal prolapse repair, even if they don’t have incontinence. Wei said it can prevent the incontinence that might result from a POP procedure.

Dr. Wei presented the data from OPUS on behalf of the Pelvic Floor Disorders Network (PFDN).

At 12 months after surgery, 27% of the women in the TVT group had urinary incontinence compared with 43% of the women in the placebo group.

Dr. Wei said there was a downside too, “Although there were no significant differences in serious and unexpected adverse events, there was a higher rate of bladder perforations (6.7% with TVT vs 0% with placebo), major bleeding or vascular complications (3.0% vs 0%), and incomplete bladder emptying (3.7% vs 0%) in the TVT group.”

Dr. Mikio Nihira, from the University of Oklahoma College of Medicine said in this article in MedScape, why fix it if it isn’t broke in that the risks may not be worth the upside. You can read a summary of the study here in MedScape. #

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