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Doctor Directory: Dr. Daniel Elliott- Urology Department, Mayo Clinic, Rochester, MN

Dr. Daniel Elliott, Mayo Clinic Urology, Rochester MN

Dr. Daniel Elliott, Mayo Clinic Urology, Rochester MN

As part of an ongoing series: Doctor Directory, Mesh News Desk  will bring you interviews with the leading doctors involved with the current transvaginal mesh issue. Most of the doctors interviewed have been chosen because they recognize mesh injuries as real and deserving of attention, however, those profiled here may have different attitudes toward treatment.

A doctor profile does not imply an endorsement.

The choice of a doctor should be an individual decision based  on a variety of factors based on a personal interview, insurance coverage, compatible philosophies and patient confidence, among other factors.

Dr. Daniel S. Elliott-Urology Department

Mayo Clinic, Rochester, MN

http://www.mayoclinic.org/biographies/elliott-daniel-s-m-d/bio-20053374

 

Dr. Daniel Elliott is with the Urology Division of Mayo Clinic in Rochester, Minnesota. Dr. Elliott says the philosophy at the Rochester Mayo Clinic is that no one in the urology department use polypropylene transvaginal mesh for prolapse. Dr. Elliot signed the Public Citizen Petition in  2011 to have pelvic mesh removed from the market. The Food and Drug Administration recently denied that petition.

The urology division is separate the distinct from the urogynecology division of the Mayo Clinic, which might not share the same philosophy. And the philosophy in Rochester MN may not extend to the other Mayo Clinics in Scottsdale, Arizona and Jacksonville, Florida.

He spoke to Jane Akre, editor of Mesh News Desk.

“When it was introduced in 2005 we said “No” to all synthetic mesh kits. No one at Mayo used transvaginally- placed synthetic meshes for pelvic organ prolapse. We perform standard repairs, such as the anterior and posterior colporophy with absorbable stitches and not synthetic meshes.”

Q: And the treatment for incontinence at Mayo?

“Most of us have tried the synthetic slings and we have written papers about the complications. No one in the urology department uses mesh slings but I cannot speak for the urogynecologists. They may at times still do it but the numbers have dramatically been reduced.”

Q: What are you seeing in terms of mesh complications?

“We are seeing a marked increase in those referred to us both in the sheer numbers and in the complexity of the complications. I see about two to five per week maybe more than that sometimes. We are dealing with a variety of complications ranging from erosion into the urethra or bladder and/or pain syndrome. Pain is the biggest thing I deal with. Going back five to six years we didn’t see it as often. Now we see it a lot. Complications due to meshes are frequently, but not always, related to time. The longer they are in, we are seeing more complications. Even five to ten years later we are seeing problems.

I’m of the opinion that we are seeing the tip of the iceberg of problems especially with mesh kits. Individuals not having problems now, we might see down the road.”

Q: Should POP (pelvic organ prolapse) mesh be reclassified?  

“Absolutely. I’ve been working with Public Citizen to reclassify this all. I’m in favor of that. That’s why we are having all these problems. Mesh flew through the approval process. It has to be reclassified.”

Q: How about SUI (stress urinary incontinence) mesh?

Obviously, there is conflicting data out there. What we don’t know are the long-term complications. The pain syndromes following mesh slings are especially difficult to treat. In my practice, I do not put in transvaginal mesh including that for incontinence.”

Q: Should it be off the market?

“Polypropylene mesh used for transvaginal prolapse should never have been put on the market. For selected individuals who have failed standard treatment for incontinence, there may be a role for meshes. However, it is my belief that it represents a small number of select of individuals who have been counseled very well on the risks of meshes. There is a swing of the pendulum going on that is away from the use of these meshes as time goes on.”

Q: What can we do for these women?

“That is a very, very difficult question. Some women when you can localize the pain right to the mesh you excise the mesh and you have a chance of curing them, however, surgery in a large number does not work and a complete explant is not an easy surgery. It does not guarantee success.

Dr. Philippe Zimmern, a urologist at University of Texas, Southwestern found that 20-35% percent of women who had meshes and were operated on for pain, still had pain after surgery. This is a very discouraging finding. Mainly because Dr. Zimmern is a highly talented pelvic surgeon, and in this extremely talented surgeon’s hands, 20-35% of patients still suffered from pain after removal of their meshes.”

Q: Do you agree with some who say the complications are doctor error and not the mesh itself?

“I can’t speak about doctor error and any individual situations. If you are working with a product that is going to scar and cause chronic inflammation and in the hands of low-volume surgeons, you are set up for trouble.  But, importantly, even high volume “experts” still report an unexpectedly high complication rate.”

Q: Can you get the arms out with, let’s say, a TVT (transvaginal tape)?

“Removal of mesh arms is a very big, very difficult surgery. These mesh kit arms are scarred in all over the pelvis. It’s is nearly impossible to get all the mesh out. It’s a highly challenging area of the anatomy.”

Q: I understand insurance will pay $1,000 for an implant but only $250 to do a four-hour explant procedure. Is that why many doctors don’t want to deal with complications?

“Insurance and billing is not an issue that I have enough knowledge to answer correctly. However, I suspect the doctors are more commonly turning patients away because it’s a very complicated surgery to remove meshes. Individuals are in a lot of pain and surgery does not guarantee it will help. It’s not straightforward what should be done with these individuals. We know that five to ten years down the road we will be seeing complications. Meanwhile a lot of doctors are putting in these devices and very few are treating complications.”

Q: Many patients never return to the doctor who caused the problems?  

“Many patients have the implant and they go elsewhere for their definitive care. The doctor who put in the mesh may never knows it’s a problem. I make sure I send a follow-up letter to the implanting physician. I make the point that the doctor knows so he or she does not assume things went great and everything is fine with the mesh.”

Q: You mean a weekend cadaver clinic won’t do it?

“Exactly. Female pelvic anatomy is very complicated. Just because you passed a board exam or a weekend cadaver lab does not mean the surgeon understands the complexity of the pelvic anatomy.”

Q: Medical societies, what can they do to help the situation?  

“They need to police themselves and take an honest look at the complications that arise from procedures. But it is important to note that just because medical societies come out in support of mesh products does not mean that all surgeons within the societies agree with that decision. I’m a member of the American Urogynecologic Association, the International Urogynecological Association, SUFU, AUA, all of the societies that support mesh products. That doesn’t mean all members within those societies support what the society’s official opinion is.”

Q: Are we seeing a great deal of conflict of interest among the higher ups?

“Anytime money is involved that definitely muddies the waters. That’s why at Mayo they have such strict rules against working with medical industry. If we are paid any money by industry, we have to declare it to Mayo. This is a very strict rule and it’s a very good rule. ”

Q: I had one doctor describe this as a ‘dark chapter’ in women’s pelvic medicine?

“That’s a good description. It’s a disappointing development especially because meshes have been around for a long time. Polypropylene has been used for hernia repair, abdominal wall and thoracic wall hernias and the complications with that are well documented. There are hundreds of papers or more dealing with the complications of hernia mesh.

“But take the same polypropylene mesh and put it in the vagina where we have alternatives, so it’s a tragic preventable development. Just take a look at general surgery data and anyone could have predicted these vaginal complications would happen, and they did. The vagina is a curved area and add to that the bacterial introduction of the implant and the stresses causing mesh to be pulled everywhere – It’s a sad chapter and hopefully we are at the end of new implantations in terms of prolapse.”

Q: I’m hearing doctors say to patients that this is the “New Mesh” and the old ones have been recalled to talk them into the procedure?

“That is a major problem and it’s a disappointing problem. At Mayo you are taught from day one the needs of the patient come first. William Mayo said that. If you strictly follow that then ties associated with industry fall away. It’s also not just tragic for the individual patient but the vast wasted medical resources for Medicare and insurance they are paying for something that is no better than traditional surgery.

“I would think the insurance companies should be seriously involved with this issue. I’ve sent letters to senators and representatives because Medicare is looking at vast amounts of money wasted because they paid for the product and surgeries and a doctor could have done a traditional repair with $8 worth of suture and not face these complications. I didn’t get anywhere with Congress with the money aspect. If we had insurance companies leading the charge making sure of the safety of new products, then this wouldn’t happen.” #

Learn More:

Dr. Daniel S. Elliott-Urology Department

Mayo Clinic, Rochester, MN

http://www.mayoclinic.org/biographies/elliott-daniel-s-m-d/bio-20053374

Dr. Elliott signed onto the original Public Citizen Petition in 2011 to have mesh taken off the market. The Food and Drug Administration recently denied that petition.

http://meshmedicaldevicenewsdesk.com/featured-articles/public-citizen-recall-synthetic-surgical-mesh/

Dr. Elliot’s Statement in Support of Public Citizen Petition

http://www.citizen.org/documents/1963-Elliott_statement_in_support_of_HRG_petition.pdf

Public Citizen Press Release:

http://www.citizen.org/pressroom/pressroomredirect.cfm?ID=3405

13 Comments

  1. Mary pat says:

    There is hope. Wow! An honest, caring doctor. Thank you Dr. Elliot. Thank you Jane.

  2. Dora says:

    Thank you Dr. Elliot, for your honest interview, there should be more docs like you, who dare to speak the real story, without frightening from colleagues pro mesh and the industries…. Listen to the feedback off the patients, they are the only talking testing persons, not the cadavers and not the New-Zeeland rabbits, the women them self knowing the truth abouth the mesh…..they know!!!

  3. Nanci Scherer says:

    I went to the mayo clinic in Scottsdale for a removal. I was messed up way worse then when I went in and then asked “are you sure you could walk when you came in” leaving in a wheelchair. They did not believe me when I asked if it was mesh related, I even have reports. Must say it was 2009 so maybe now they believe.

    • Jane Akre says:

      Nanci- It would be nice if system wide Mayo Clinic would adopt the stance of Dr. Elliott…. but sadly that does not appear to be the case. Mayo Clinic- Are you Listening? Hello? ~ ja

    • Bev says:

      You did not specify if you had a portion or full removal.

      My partial was a disaster my full removal much better.

      It is likely you only had a partial. A partial is worse than leaving it in.

      Dr Raz at UCLA is one of the very few that can do a full removal. Go see him and get his ultra sound done. He has the only machine that can see the mesh.

  4. Jan Urban says:

    Great interview Jane. Thank you. Yes we surely do know the truth about Propylene Mesh and I am sure the FDA knows, the members of the House Committee on Energy and Commerce knows, and most certainly, the GAO knows this. And recommends that FDA expeditiously take steps to issue regulations for class III device types that are currently allowed to be marketed by the 510(k) clearance and to require PMA’s or reclassifying them to a lower level. This was in 2009. A Cover Letter, dated January 15, 2009 to Senator Edward Kennedy and others titled FDA should take steps to ensure that high risk device types are approved through a stringent premarket review process according to the study by the GAO. The FDA agreed with this and a lot more that was recommended. Agreeing is fine. But we have not seen any implementation of any of these recommendations by the GAO made in 2009. Something is seriously wrong here. Apparently, all parties read the findings and agreed and that was that. So here we are nearing the end of the year 2014. and no resolve. Like I said, At the White House Web Site we can submit a Petition calling for A Congressional Investigation. Everything we need is on the site.. We need 150 signatures within a month and then 100,000 the second month for it to be considered. Check it out. For more details. We have plenty of friends and family that would sign so it’s not the numbers that will stop us. I just do not know how to write it. Let’s check into it.!!!

    • Pam W says:

      Jan, I really like that idea, and that is something that we all should be looking into. I am certain I could get a thousand, or near it. There are thousands of us in the groups with resources to get this done, and we do have family and friends willing to support us in doing just that. It’s about protecting our future, and educating society and doctors so that we all may have a good life again.

      I appreciate this Doctor Elliott going on record. This will also help with all our insurance appeals, and disability to get by until we are able to work again. I pray daily that we keep up our persistence, and don’t just give up. I know how frustrating it is trying to get medical help, and no one seems to want to listen. I’m nearly expert in the area, and if I was able to do clinicals Im sure I could pass a state board test. But I’m not able to work!!! Sadly, I am fully aware that is the case with most of us, and we all would be willing to help others if we were able to get out and do it.

      Such a shame on the Medical Departments and Pharmaceuticals to only care about money rather than our health and safety. In addition our quality of life is meaningless, but by Grace of God we have persistence. I know we will see a breakthrough, and I just pray it’s soon. We all deserve to have a new life again, and end this suffering.

  5. Disgusted says:

    Thanks Jane! I’ve said this myself – “That insurance companies should be leading the cause to stop this product”. I’ve written to my insurance company. No answer. Just denying coverage for the complications, increasingly – due to health care reform. The issue being that the insurance companies look to AUGS, the professional journal, who is in bed with the pharmaceuticals. The word “experimental” before “transvaginal mesh” is removed and the we have a time bomb put on the market. Destroying lives, families and communities. Any brakes put on – ie. the malpractice company trying to stop covering transvaginal mesh and there is an outcry. This would cut into profits! It is not about people, it is about money. Politics are driven by money. Most of us are being bankrupted by this travesty. I am thankful for the handful of Dr.’s who have ethics – but most do not. Such a sad commentary in the 21st century. This is indeed the darkest chapter in women’s health history.

  6. jade says:

    BOTTOM LINE: It’s all about the “money”. And, the implanting doctors are whores of the manufacturers. Period.

    Q: Are we seeing a great deal of conflict of interest among the higher ups?

    “Anytime money is involved that definitely muddies the waters. That’s why at Mayo they have such strict rules against working with medical industry. If we are paid any money by industry, we have to declare it to Mayo. This is a very strict rule and it’s a very good rule. ”

  7. Jane R. says:

    Wish my doctor would make this statement. I don’t know how some speak out and others just say the mesh isn’t causing you the pain.

  8. Jan Urban says:

    GO to: https://petitions,whitehouse.gov The White House Web Site is well worth a browse!

  9. Richard Howden aka All Meshed Up says:

    It is VERY refreshing to read the things this Dr. said in your interview,Jane. Here is a Dr. that knows what Polypropylene does in the body. Whether Gynecological or Hernia mesh, none of it is good. I was especially interested in his thoughts that as time goes by, a PP implant gets worse for the implanted. As I go into my ninth year with a Polypropylene mesh in my gut, I know exactly what he means.

    He also said something that I have said here before, there was Hernia Mesh complications already documented before there was Gynecological mesh. There was documented evidence in abundance! There was enough complications that Gynecological mesh should have never made in into the populace. But it did. And his other comments also mirror what I, and many other on here have stated, this is about money. Nothing more. And the Doctors jumped in with both feet and implanted as many men and women as they could, as fast as they could. And when even more complaints came in, especially from the newly implanted women, we were ALL ignored. Not only were we ignored. We were berated, called ignorant or drug abusers or worse. And here we are several years later and all that we have experienced and suffered through is confirmed by one honest Doctor from the Mayo clinic.

    God Bless him for at least confirming that for us. Thank you Jane for another great interview.

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