FDA Convenes Panel on POP Mesh in February 2019

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FDA Convenes Panel on POP Mesh in February 2019

Mesh Medical Device News Desk, November 22, 2018 ~ The FDA continues to explore what went wrong with mesh for pelvic organ prolapse and will rely on the public and experts to weigh in on February 12, 2019. 

The U.S. Food and Drug Administration has slowly reacted to events concerning polypropylene mesh for pelvic organ prolapse or POP.

These larger meshes packaged into kits in a one-size-fits all have resulted in some of the most severe complications among the women who were permanently implanted. Estimates are up to 200-thousand woman received these PP mesh implants made by AMS, Boston Scientific, Johnson & Johnson and C.R. Bard. They are among the most difficult to remove.

POP mesh is used to support the pelvic organ that can drop or prolapse from their normal position. They include the vagina, cervix, uterus, bladder, urethra and rectum. A traditional repair, before mesh, involved suturing the organs in place.

Prolift, MedTech Marketing

All but a few have been quietly removed from the market

This week the FDA announced it will convene an expert advisory committee on POP in February to share the available evidence and hear from the public. *New Add*

Meeting Location: Hilton Washington, DC North/Gaithersburg
Time:  8:30 am ET to 6:30 pm

Here are panel members.

Panel members will  weigh in on the transvaginal placement of POP mesh in the anterior vaginal compartment – its risks and benefits and identify the appropriate patient population.  Also physician training will be addressed.

There is no mention of the smaller but also problematic mesh for stress urinary incontinence (SUI) which largely remains on the market and which one largely industry funded medical lobbying group refers to as the Gold Standard.

Of the 150-thousand or so defective product lawsuits filed in the  U.S. the majority are for SUI mesh.

How to Submit your Comment to the Federal Register, go HERE!
Electronic comments must be submitted by February 11, 2019. 

BACKGROUND

Dr. Shlomo Raz, UCLA Urologist

The history of PP mesh is a short one but full of stories of pain and lives lost.

While PP mesh works for some people, at least in the short run, one of the most experts in mesh removal says he stopped putting it in when he saw complications ten years later.  Dr. Raz now spends his years at the urology department of UCLA seeing the most seriously injured women from around the world.

Prolift, made by Johnson & Johnson, entered the market in March 2005, with no FDA clearance.  Discovery at trial has shown us that J&J didn’t feel it needed to alert the FDA because the basic PP suture material called Prolene had already received FDA clearance.  (see Linda Gross trial).

By 2008, the FDA noted an increase in mesh-related injuries and concluded that pain, chronic infection, mesh shrinkage and erosion were “rare” occurrences.

By 2011, the FDA convened a public meeting of the Obstetrics and Gynecology Devices panel which decided that POP mesh complications are “not rare” and that POP mesh may not be more effective over traditional non-mesh repair.

The FDA agreed to review POP mesh on the market, a difficult task because there is no reliable and consistent post-market registry. The responsibility fell on the mesh manufacturers.

The FDA’s 522 orders, as they are called went to 34 manufacturers to find out how women were doing after their implant. Currently there are four ongoing 522 studies for five devices.  Some such as J&J, opted to remove Prolift from the market by mid-2012.

The FDA then relieved the company of looking any further into the complications from Prolift recipients, despite the fact that the mesh was permanently implanted and for some, continued to do harm.

By January 2016, the FDA reclassified POP surgical mesh as class III, normally reserved for high risk devices, which many argue it should have already been considered. Class III means a manufacturer could not market its POP mesh unless and until it passed a higher level of scrutiny by the FDA known as premarket approval or PMA. The expert panel had suggested this move back when it met in 2011, five years earlier.

While most POP meshes were removed three surgical meshes for POP remain on the market while the FDA considers whether they should be there.  They are Artisyn- Y-Shaped mesh, used for sacrocopopexy by Ethicon, Uphold Lite vaginal support system Boston Scientific, and Upsylon Y-Mesh by Boston Scientific.  All are made of polypropylene.

WHAT TO DO

  • Mark your calendar – A public turnout for this meeting will allow mesh recipients to talk directly to regulators.
  • Enter comments into the Federal Register when it is posted. Mesh News Desk will will publishing the time and place and federal register locations.
  • Watch who is on the panel – Scrutiny of those selected to be on the panel will be watched, as in the past, some members looking to approve devices have been in financial conflicts of interest with the very companies they are reviewing.

LEARN MORE:

FDA Announcement, November 20, 2018
https://www.fda.gov/medicaldevices/productsandmedicalprocedures/implantsandprosthetics/urogynsurgicalmesh/

2011 Meeting Materials of the Obstetrics and Gynecology Devices Panel
https://wayback.archive-it.org/7993/20170403223431/https:/www.fda.gov/AdvisoryCommittees/CommitteesMeetingMaterials/MedicalDevices/MedicalDevicesAdvisoryCommittee/ObstetricsandGynecologyDevices/ucm262488.htm

December 2015, Orders Federal Register, PMA required by July 5, 2018 for POP mesh, Class III
https://www.federalregister.gov/documents/2016/01/05/2015-33163/effective-date-of-requirement-for-premarket-approval-for-surgical-mesh-for-transvaginal-pelvic-organ

Mesh News Desk, July 10, 2018, 30 Months is Up! POP Mesh is Officially High Risk, Too Late for  Many
https://www.meshmedicaldevicenewsdesk.com/30-months-is-up-pop-mesh-is-officially-high-risk-too-late-for-many/

Federal Register, January 5, 2016, Obstetrical and Gynecological Devices; Reclassification of Surgical Instrumentation for Use with Urogynecologic Surgical Mesh (here)

FDA Urogynecologic Surgical Mesh: Update on the Safety and Effectiveness of Transvaginal Placement for Pelvic Organ Prolapse, July 2011 (here)

FDA, Concerns about Surgical Mesh for POP, July 13, 2011 (here)

MND, Jan. 2012, Mesh Makers who Received 522 PostMarket Surveillance Orders (here)

MND, March 2013, SUI Injury Reports to FDA up 36 Percent (here)

FDA Final Order – Letter to mesh makers for 522 studies, January 2012 (here)

MND, January 9, 2012, Mesh Makers who Received FDA Letter Requiring Postmarket Surveillance (here)

MND, AUGS Prolapse Consensus Conference Announced with Patient Advocates, October 16, 2016 (here)

Time to rethink: an evidence-based response from pelvic surgeons to the FDA Safety Communication:
“UPDATE on Serious Complications Associated with Transvaginal Placement of Surgical Mesh for Pelvic Organ Prolapse”
from the Pelvic Surgeons Network, January 2012 (here)

MND, What Happened to the FDA Request for Transvaginal Mesh Studies? September 19, 2012 (here)

June 4, 2012, Ethicon letter to Judge Goodwin, it plans to stop commercialization of four meshes (here)

MND Mesh-Injured Patient Researches ProteGen Mesh Predicate, November 8, 2011 (here)

News Release, April 4, 2018, Female Pelvic Implants Market to reach a value of over US $300 Mn by the End of 2027 (here)

BMJ, December 2017, Trials of transvaginal mesh devices for pelvic organ prolapse: a systematic database review of the US FDA approval process (here

By | 2018-12-11T15:02:35+00:00 November 22nd, 2018|FDA News, News|4 Comments

About the Author:

I’m National News Editor, Jane Akre and I began Mesh Medical Device News Desk aka Mesh News Desk (MND) in the summer of 2011 just after the Food and Drug Administration issued an explicit warning to the public that complications associated with surgical mesh used for prolapse repair (POP) and incontinence (SUI) are NOT rare! That was the starting point for the litigation you see today and thousands of lawsuits have been filed by women whose lives have been altered, some permanently, by the use of this petroleum-based product.

4 Comments

  1. Julie M9ntague November 22, 2018 at 5:58 pm - Reply

    How many complications have been reported by the worldwide countries who have been supplied with these meshes (medical devices). The have not gone through any rigorous testing which should be followed in any medical practice procedure worldwide? This has got far too much profit value over that of quality for a human life of the patients who have had plastic mesh implants.

  2. Diva64 November 24, 2018 at 10:37 pm - Reply

    So strange they don’t want to include those that had it for urinary stress incontinence.
    I myself was implanted by with one or two of the companies mentioned above and have been sick and I pain ovee 10 years . Dr Raz,says I can’t be helped it will only increase my pain . He was my last hope. But since seeing him in May 2018 . There is no one left ,so i will never get better. Many women have had surgery to remove the mesh however continue to battle life long problems from the mesh being put into their bodies to begin with. I believe the UK haa,banned it all together . I view it only as a way to reduce the population .

  3. Wren November 25, 2018 at 12:02 am - Reply

    Jane, I heard it announced on Friday,Nov 23 that NBC Nightly News iwith Lester Holt will be presenting facts about medical devices in the US and around the world. They did a piece on a shoulder device that was implanted in a man in Europe that was defective and made here in the USA but would not pass FDA standards here. This series is to continue all week. It will be interesting to see if they broach the subject of mesh devices.

    • Jane Akre November 25, 2018 at 11:41 am - Reply

      Yes agreed. Ever since The Bleeding Edge, it’s as though the veil of secrecy has been lifted from the eyes of the media. I’m frankly shocked how little they know about this topic. I will reach out to NBC News…..Please write them online and let them know your circumstance…….

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