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Vaginal Mesh: Is your television your doctor?

Navigating the many sources of information around surgery for pelvic prolapse and urinary incontinence

pelvic meshYour phone blinks constantly with news alerts. Your electronic tablet is full of news apps. The Internet provides thousands of websites within a second of your search. Facebook and other social media sites suggest many references you might be interested in. Your mother just saw a commercial on daytime television, and your friend is full of stories of things that definitely happened to her friends.

Today we are bombarded with information from many sources, and trying to know where to start and what to believe can be a bewildering process. The amount of direct-to-patient marketing has never been higher. While this is true of all topics in medicine, recently the controversy concerning vaginal mesh has taken center stage. FDA alerts and new research studies, along with many patient complications, have fueled a litany of legal advertisements on television, radio and the Internet.

‘Vaginal mesh’ is a complicated topic. The term itself is vague and includes mesh using during surgery to treat pelvic organ prolapse (“dropped” organs such as the uterus or bladder) and/or urinary incontinence.

All vaginal mesh, though, is not the same.

  • Mesh used as ‘slings’ to treat urinary incontinence has been used for more than 10 years in the United States safely and with excellent success rates.
  • Mesh placed through an abdominal incision – or, now, using laparoscopic or robotic surgical techniques – to correct vaginal prolapse has also been used safely and effectively for many years.

Because there is a 30% risk of recurrence of prolapse after surgery, physicians in this field are constantly seeking a better surgery that will eliminate or reduce the need for additional surgery. As part of that process, a few years ago, doctors started using prepackaged ‘kits’ containing a mesh implant placed through the vaginal opening to correct prolapse. Often these ‘kits’ came with devices used to place the mesh through small incisions in the upper thigh.

The goal was to perform minimally invasive, high-success surgery, which appeared possible. However, these higher success rates were balanced by higher risks. Complications reported by patients included pain, difficulty with sex, and exposure of the mesh material in the vagina (sometimes called an ‘erosion’). These can be difficult to treat afterward.

The FDA has released several statements about the placement of mesh through the vagina to correct prolapse, and is currently investigating these products through much more extensive research than has been required previously. Several products have been removed from the market.

The evolution of the use of mesh ‘kits’ and the subsequent controversy is easily accessible online to patients and physicians alike. If a patient searches for ‘prolapse surgery’, she is very likely to find legal information as one of the top hits – even higher than highly reputable medical sites. Television commercials have advertised widely about several large class-action lawsuits, and many women seem to know at least one other woman who had a negative experience.

These messages, which are nearly constant once a patient starts paying attention, are likely to impact her thoughts about her own personal medical care. In our daily practices here at the University of Michigan, we started to notice that women expressed skepticism, doubt and concern about nearly all surgery options for prolapse and incontinence, based on information they’d gotten prior to their visit.

informed healthcare decisionsIt was difficult in some cases to help patients differentiate the facts from the misinformation out there, regardless of the data. From extensively talking to these patients, we saw common threads and designed a study to take a closer look at our patients’ knowledge and perception of vaginal mesh surgery. The study was conducted during 2012 involving new patients coming to see a urogynecologist at the University of Michigan. We presented the results at the annual meeting of the Society of Gynecologic Surgeons earlier this year and recently the paper was published in the Journal of Female Pelvic Medicine & Reconstructive Surgery.

Our study found that two-thirds of the women surveyed were aware of the controversy over vaginal mesh. About 58% of women got their information from television commercials, and it was much less common that women had information from a medical professional. We identified some points of incorrect information, including that the mesh needed to be removed due to the recall and even that it can cause cancer. One in five women told us she would refuse any mesh surgery as a result of what she already knew – before she had even met with one a physician. From our data we saw that overall level of concern about mesh, getting information from friends/family members and knowledge of class-action lawsuits all predicted this inclination to refuse surgery.

Urinary incontinence and prolapse can be embarrassing and socially limiting conditions, and it may take a patient years to build up the courage to seek care for these problems. Treatments that were used in the past had lower success rates than our current methods, but there are now many “non-mesh” options that we use here at the University of Michigan to help women overcome these problems. Surgery is never the only option, but there are great, safe choices. Some of these choices do involve mesh placed in a different manner than the products that caused high complication rates.

We hope the study gives us direction as to how to address patient concerns but still provide excellent, low-risk care. We also hope patients are able to keep an open mind – listen to your doctor at the end of everything, not your family member, friend, television or computer screen.

Take the next step:

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wh blog - megan schimpfMegan Schimpf, MD, completed her undergraduate and medical education at the University of Michigan before going to the University of Connecticut for residency training. She completed her fellowship in Female Pelvic Medicine and Reconstructive Surgery at Hartford Hospital before working on the faculty at the University of Pennsylvania at Pennsylvania Hospital. Dr. Schimpf is now board certified in both Obstetrics and Gynecology and Female Pelvic Medicine and Reconstructive Surgery. Her clinical interests include surgical outcomes, impact of obstetrics on the pelvic floor, vaginal and robotic surgery for prolapse along with urinary incontinence treatments. With a background in journalism as well, Dr. Schimpf believes that no one should have to suffer or limit themselves due to pelvic floor disorders.

 

university of michigan women's hospitalThe University of Michigan’s Women’s Von Voigtlander Women’s Hospital is a leader women’s health care.  Consistently ranked among the America’s top gynecology programs by U.S. News & World Report, U-M is committed to unsurpassed patient care for women.

 

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