A woman who I am planning to do a Patient Profile on called me the other day. She had surgical mesh partially removed at the Cleveland Clinic with urologist, Dr. Howard Goldman, two weeks ago. She was on her way back to the Cleveland Clinic in extreme pain. She had been on the same antibiotic for two years and now had a high white cell blood count, she said. This woman’ didn’t sound good and cried on the phone but she refused to go to an emergency room because, she said, they didn’t know how to treat her.
I wanted to follow up with Dr. Goldman’s office to find out how he feels about partial mesh removals. Last week Dr. Goldman’s videos (here) featuring a partial mesh removal “excision” and a mesh “incision,” where the mesh is cut to relieve tension, shown on YouTube, made their way to MDND and many readers complained believing that contributes to a worse outcome. While some doctors who advocate full mesh removal would agree, Dr. Goldman says that’s not his experience.
MDND: Are partial removals the answer for mesh removal?
Dr. Howard Goldman: “We do removals specific to the area bothering the patient. Whether the mesh is extruded or exposed and is causing pain we remove what’s bothering her and we only try if it’s causing problem.
“As far as a total removal, I’ve seen patients ended up with major vascular or bowel issues and severe complications. If they have vaginal symptoms, we remove that portion and do not dig into their thigh. We do not want to make them worse.”
MDND: Do you not believe in the systemic response to mesh?
Dr. Goldman: “Mostly what we see are not systemic but localized symptoms. We have had a systemic response and we did go after more of it only in a specific situation. But if there is pain in an area or the mesh has eroded, we take care of that and they feel fine.”
MDND: Women I’m hearing from are are devastated and debilitated with pain all over. Some go to see Dr. Shlomo Raz at UCLA who is seeing patients all over the world for mesh removals.
Dr. Goldman: “You may be seeing the tip of the iceberg, the ones who are devastated and debilitated. In our paper which appears next month in the Journal of Urology, we looked at life after 20 odd vaginal mesh kits, and the vast majority had localized treatment and after three months and six months they did well. I’m well aware of Dr. Shlomo Raz and his thoughts and I’m well aware he is a great surgeon. I’m also aware that he’s a most vocal proponent of not using mesh. He was the most vocal proponent of using mesh.
“But we’re seeing a lot of women who have had more damage from the removal. People don’t realize the physicians have to have a lot of experience in this area.
MDND? What should you ask?
Dr. Goldman: How many have you done and completely taken out?
MDND: How many total removals do you do of the people who come in with complications?
Dr. Goldman: “We don’t have data but it’s not the majority, hardly any.”
MDND: Dr Donald Ostergard says mesh is not inert. See background story here. Do you agree?
Dr. Goldman: “It’s the same stuff that is used in vascular surgery; the same suture material. I can tell you among the slings, the vast majority are doing fine.”
MDND: How about the more mesh the more mess?
Dr. Goldman: “Were seeing a lot of technical issues – some surgeons without good outcomes.
“There is a paper from a few years ago – Ridgeway, B. is the first author, and in the new one the first author is Firoozi, F. Find it in PubMed to get the Abstract.
“The vast majority with localized treatment at the three-month and six-month follow-up did well. I’ve seen your site and I’d like to think you are seeing the tip of the iceberg, not to discount that some women are in really bad shape with serious problems.”
MDND: Any idea of the complication rate?
Dr. Goldman: “We know from a number of studies the pain, erosion and extrusion rates when compared to no mesh. We do need more data.” #
Journal of Urology, Purly Transvaginal/Perineal Management of Complications From Commercial Prolapse Kits Using a New Prostheses/Grafts Complication Classification System, March 14, 2012
During the study period of November 2006-2010, 23 women were followed after having transvaginal mesh from prolapsed kits removed after experiencing complications. The average age was 61 and the median period of time until complications was 10 months. Complications included pain, extrusion, incontinence, prolapse, perforation and urinary tract infection, “Purely transvaginal mesh excision appears to be safe with resolution of almost all presenting symptoms.”
Editors Note: It’s unclear from this article whether or not the mesh removal was complete or arms and anchors were left behind. *
Dr. Donald Ostergard on Degradation, Infection and Heat on Polypropylene Mesh
International Urogynecology Journal, November 2010, Dr. Donald Ostergard
Articles on Tape Removal- PubMed