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Dr. Raz Tells Docs Why He Will Not Use Synthetic Mesh Slings!

Dr. Shlomo Raz, UCLA Urologist

Dr. Shlomo Raz, UCLA Urologist

Mesh News Desk, April 7, 2016 ~ World famous urologist said too many complications arise even years down the road, made him stop using mesh.

For those of you new to the mesh debate, this explanation by Dr. Shlomo Raz, a urologist from UCLA, lays out the debate.

A 29 minute webcast at the annual meeting last year of the American Urological Association (AUA) entitled “Surgery for Stress Incontinence – With vs. Without Mesh,”  features two prominent doctors debating the use of pelvic mesh – Dr. Paulo Palma, a professor of Urology from Brazil (pro mesh use) and Dr. Shlomo Raz, urologist from UCLA.

Made of polypropylene plastic, surgical mesh is used to help reinforce tissues that may have allowed organs to fall in the pelvic floor.

Dr. Raz had used polypropylene implants and taught its use for many years before noticing that some of his patients returned, some up to a dozen years later, with pelvic mesh complications.  Others have noted that mesh is not inert, meaning it takes on a life of its own and is constantly undergoing changes including, but not limited to, degradation, erosion, shrinkage, contraction.

Dr. Paulo Palma, Urologist, Brazil

Dr. Paulo Palma, Urologist, Brazil

Dr. Paulo Palma, defends implanting synthetic slings with mesh to treat stress incontinence as does AUGS, the American Urogynecologic Society.  He calls them minimally invasive, and a gold standard and a successful surgery. He says there is a 49% cure rate for Burch Procedure, 66% cure rate for incontinence with a sling.

TVT-S

TVT-S

In this 30 minute webinar, Dr Palma says the worst fixation of a mini-sling was the TVT-Secur which is no longer on the market.

About 15 minutes in, Dr. Raz says many mini-slings were ineffective and that’s why they are off the market. Even though he had a good result after implanting about 1,800 distal urethral implants with 10 cm of soft prolene mesh attached to a vicryl suture, he would note erosion, UTI’s and pelvic pain, five to ten years after implantation. As a result he has abandoned the use of synthetic mesh.

A five-year Longitudinal Follow-up after TVT and TVT-O implants found treatment success declined over a five year period for mid-urethral slings.

In the last five years, Dr. Raz says he has removed about 1,300 mesh implants due to erosions, vaginal pain and infections.

Why do they occur?

Biofilm

Biofilm

To answer that question, UCLA started a Biofilm Project. Beginning with 1,300 patients with sling procedures mesh segments were taken from the midline and distal area (away from the midline)  and amplified to discover live bacterial biofilm colonies growing in the mesh.

The theory is that unavoidable contamination with vaginal bacteria during placement may result in bacterial biofilms on the mesh.

“Twenty percent of the patients with mesh removed have systemic symptoms  – skin rash, losing hair, lung issues, sinuses – we are looking at the immunology of the chronic bacteria creating systemic effects.”

Fascia harvested from Ilio band

Fascia harvested from Ilio band

As a result, Dr. Raz abandoned totally synthetic mesh slings. Today he does fascia lata and bladder suspensions, which have a good patient outcome.

Taking the facial sling from the  Ileo-tibial band in the leg to harvest 5 to 10 cm of  tissue, then using a fascial stripper to cut the sling results in what Dr. Raz calls an excellent quality sling with minimal pain and quick recovery.

Harvested fascia lata

Harvested fascia lata

“I agree, mesh is a good surgery for incontinence, but I , after doing so many, have discovered I cannot do it anymore. I don’t provide a good care for my patients because I discovered you put mesh through a contaminated vaginal area, and the patient with pelvic pain bacteria DNA causing live bacteria in the mesh that can cause potential problems.”

Three million slings have been done he estimates. Last year’s publication of a five year longitudinal followup study of slings finds their effectiveness decreased over time as did quality of life issues.

Listen to the webcast here.raz and suzanne mcclain

 

LEARN MORE:

MND, June 24, 2015 ~ The Role of Bacterial Biofilms 
https://www.meshmedicaldevicenewsdesk.com/the-role-of-bacterial-biofilms-in-pelvic-mesh-slings-for-incontinence/

5-Year Longitudinal Follow-up after Retropublic and Transobturator Midurethral Slings, J Urology 2015, Jan. 
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4272663/

Dr. Palma  – 2005 Transobturator SAFYRE sling is as effective as the transvaginal procedure.  Intl urogyn J pelvic floor dysfunction. (TVT vs TOT).   http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3997832/

Dr. Palma wrote about Primary fixation of mini-slings, a comparative biomechanical study in vivo, March-April 2012 Int Braz J Urol. http://www.promedon.com/news/archivos/PrimaryFixation-Palma_253_260.pdf

Nilsson CG, Palva K, Aarnio R, Morcos E, Falconer C, Int Urogynecol J 2013 Aug:24, 17 years follow up of tension free vaginal tape procedure for incontinence. http://www.ncbi.nlm.nih.gov/pubmed/23563892

28 Comments

  1. K says:

    One doctor removes 1300 mesh implants!!! FDA listen up!!! This is rediculous!! How many implants have been removed worldwide???

  2. Barbara Melling says:

    I am glad some doctors really care!
    This mesh is a dangerous toxic mess
    If I had known I never would have had it, and I dident know I was tested like a human lab rat they never said plastic would be in me! I would have said No
    I’m allergic because I am to any heated plastic.

  3. Kitty says:

    DR RAZ is so wonderful.

  4. Maxine King says:

    What about mesh implanted for rectal prolapse? Same sort of outcomes?

    • Kitty says:

      I think the rectal mesh is biologic and when it fails–it just turns into a mound of scar tissue

      • Jane Akre says:

        Rectal mesh can be pure polypropylene and most often is is my understanding. This is a tricky area to put plastic mesh in that any perforation of the colon can lead to sepsis….
        When someone dies of sepsis, as Patty Duke recently did, I always wonder if they have polypropylene mesh anywhere near their colon.

        • Mary Pat says:

          I was wondering if Patty Duke had mesh also. I know someone who worked with her. Patty was quite active woking in a local theatre. I will try to find out.

        • Nameless says:

          Jane, I never thought about the colon perforated before. Oh, dear. Why did I let him do it. He’s the top colon guy at NY Presbyterian. I mean the very top. I thought if anyone knew what he was doing it would be him. Wrong on my part.

  5. Kitty says:

    Dr Raz has integrity to own up to mistake of using mesh–other “old guard” DRs’ continue to keep implanting without regard to safèty.

  6. Shanna says:

    I had a mesh nightmare for 5 years. I went to 3 Drs. All said yeast infection. Dr Raz was the only one who listened to me. Mesh had eroded into several areas. He saved my life!!!

  7. Rose says:

    I had mesh implants & tape 8 years ago, have erosions, pain, irritation, constriction,
    I live in Australia. Does anyone know of a Dr with expertise in removing the mesh in Australia ?

  8. Lauren says:

    Dr. Raz saved my life. He is a saint. Other doctors said it was all in my head and I should see a psychiatrist. 10 years of suffering before I found Dr. Raz, I’m slowly coming back from the dead. Hopefully, more surgeons will pay attention now that we have this study!!! Thank you so much for fighting for us Dr. Raz, I love you!!! And thank you Jane for all the work you do to expose these powerful manufacturers that control the FDA. The Internet is our saving grace, ladies and gentlemen. 10 years ago there was no way to access this information.

  9. Rhonda says:

    Dr. Raz – Thank you for being a doctor willing to listen to women when we say something is wrong. Also for backing the ones of us who have had issues. Jane – Thank you for all the info I have found because of you. God bless.

  10. Nameless says:

    I had a rectopexy. The rectal sling was made of Gore Tex. When I queried the doc about putting more mesh in me (first poly) he swayed me by continuing to hype Gore Tex as safe. I so regret this. I have serious sacral pain and the docs promise to stand by his surgery was just hot air. I want it all out and I’ll wear a bag with pride. Any problems with that – I’ll deal. Being slowly poisoned. I don’t think they care. As I disappear into my cocoon. I see dr Blavais this week. Maybe he can help. Rectal mesh is not always biologic. Again it’s up yo the dr you are using. Do not let yourself be swayed as I did.

  11. anna says:

    I wish we had Doctors like him in NJ and NY.

  12. Kitty says:

    My understanding is PELVIC mesh is one of the meshs’ that is a problem. It is biologic. Why is it a problem? A heap of scar tissue near the rich nerve bed is not a pretty picture.

    • Kitty says:

      I meant to say “PELVICOL” not pelvic

    • Jane Akre says:

      Pelvic mesh means its mesh put in the pelvic area, abdominally or transvaginally. It can be polypropylene (PP) porcine (pig) bovine (cow) or a composite (porcine and PP for example). Dr Raz will not put PP in the body any longer is my take away from this… due to the large number of complications he sees later, that would include all meshes I believe since they are all synthetically manufactured, but that point could use further clarification. We’ve seen the same chronic infections etc from bovine, porcine and composites as pp meshes.

  13. Kitty says:

    The whole transvaginal approach is the problem.

    • Nameless says:

      Kitty, I agree from what I’ve read the transvaginal approach has significant issues. I just need to add that I had an abdominal surgery because of too many adhesions. And I think the surgeon was avoiding transvaginal. I have multiple problems post surgery. Foreign body rejection can happen with an open abdominal. I have at least six auto immune reactions some minor some not so minor. My surgeon was a skilled professional and yet I have debilitating pain in my sacrum that feels like a nail is being driven into my spine. The transvaginal emphasis is one area that the lawyers and some doctors point to. It’s the mesh and only the mesh. It should not be placed in humans. It is an artificial quick money maker. We have all been sold a deadly lie.

      • Jane Akre says:

        Nameless- did you find a law firm to take your case with an abdominal placement. Ive heard some do….

      • Still Standing says:

        Nameless, what has your physician done to help,with sacral pain? Do You take any neuropathic pain meds or muscle relaxers? Have you tried baclofen suppositories? I, too, had terrible sacral pain, so painful to sit I didn’t for months. I had transvaginal mesh as well as abdominal sacracolcopexy. It could be a muscle pain issue. They naturally tighten and shorten with pain so some medications can help as well as pelvic floor physical therapy. Let me know what younhave tried so far.

  14. Nameless says:

    Yes. My case was accepted. I know some parse out over trans or abdominal. I think it mattered more that it was Boston Sci, the batch # was on the list. Lucky me! What an ironic issue. Once again, it seems to depend on the firm. The manufacturer was crucial.

  15. Kitty says:

    Scar tissue and adhesions are very problematic–Especially in that area.

  16. PLC says:

    I wish we had
    doctors here in
    Canada like Dr.Raz.

    I have been going through this nightmare for 12 years with surgeries, medications etc. I continue to deteriorate each year.
    I feel so lost, helpless, frustrated and neglected by the medical system here It’s not bad enough you have to try to get through each day as it is and then find the strength to have to fight to get back some kind of quality of life by a medical system that just does not help nor seem to even care

  17. Kim N says:

    I’m so behind on all these articles.. I have no idea who to even see about this in my city. I can’t even find a regular family doctor in my town that I like with only having an HMO insurance never mind finding a doctor for this..

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