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[Slings in the era of the mesh ban: now what?]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:165-170. [PMID: 36607437 DOI: 10.1007/s00120-022-02017-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Use of midurethral slings (MUS) as gold standard for stress urinary incontinence declined after the recent US Food and Drug Administration (FDA) communication. OBJECTIVES What is the current status in the surgical treatment of stress urinary incontinence? What impact do regular FDA communications and numerous restrictions around the world have? MATERIALS AND METHODS The current literature on surgical treatment of incontinence was evaluated; medical press information and literature regarding the FDA communication were assessed. The legal situation is illustrated using the example of the Montgomery case in England. RESULTS Despite positive results from literature and gynecological and urological societies, there has been a significant decline in the use of MUS. The current 2022 German interdisciplinary 2k-guideline for the treatment of female stress urinary incontinence confirms the efficacy and safety of MUS. CONCLUSION Analysis of recent literature supports the importance of continued long-term outcome data regarding the safety and efficacy of suburethral slings for treatment of female stress urinary incontinence.
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2
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Shek KL, Dietz HP. Ultrasound imaging of slings and meshes in urogynecology. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:526-538. [PMID: 33206433 DOI: 10.1002/uog.23545] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/30/2020] [Accepted: 11/06/2020] [Indexed: 06/11/2023]
Abstract
Imaging is used increasingly in urogynecology. One of the main applications is in the assessment of synthetic implants. Ultrasound is particularly useful for this purpose as most such implants appear highly echogenic on ultrasound but are not visible using other imaging techniques. The worldwide success of synthetic mid-urethral slings, introduced in the late 90s, led to the subsequent introduction of transvaginal mesh in 2003-2004. Widespread use of synthetic implants for both urinary incontinence and prolapse has caused a rise in implant-related complications and increasing negative publicity and litigation, with many products removed from the market. It is not surprising that there is increasing demand for the assessment and evaluation of sling and mesh implants using imaging. This review article discusses the role of translabial/transperineal ultrasound in the evaluation of synthetic implants used in the treatment of urinary incontinence and pelvic organ prolapse. The discussion focuses on those applications of the technique that are useful for surgeons dealing with patients after mesh and/or sling placement. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- K L Shek
- Liverpool Hospital, Western Sydney University, Liverpool, Australia
- Nepean Clinical School, University of Sydney, Penrith, Australia
| | - H P Dietz
- Nepean Clinical School, University of Sydney, Penrith, Australia
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3
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Mathieson R, Kippen R, Manning T, Brennan J. Stress urinary incontinence in the mesh complication era: current Australian trends. BJU Int 2020; 128:95-102. [PMID: 33226698 DOI: 10.1111/bju.15302] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To examine available data relating to the surgical management of stress urinary incontinence (SUI) in Australia before, during and after a well-publicized Senate Inquiry into transvaginal mesh use and to consider outcomes in the context of global guideline changes. PATIENTS AND METHODS The annual number of surgical procedures for the management of SUI by procedure type and age group for the years 2008/2009-2017/2018 was obtained from the Australian Government Department of Human Services database using Medicare Benefits Schedule item numbers. The data extracted were limited to women aged 25 years and older. These data were used to calculate age-specific and age-standardized rates, so as to accurately analyse trends in the usage of different procedures. Hospital Episode Statistics for mid-urethral sling (MUS) insertions were obtained for England's National Health Service from the Health and Social Care Information Centre for the years 2008/2009-2016/2017. These data were also used to calculate annual age-standardized rates for comparison purposes. RESULTS Rates declined for most SUI procedures over time (MUS, colposuspension, fascial slings) except for urethral bulking agents. The absolute number of MUSs implanted in 2008/2009 was 5729, which decreased to 3127 in the 2017/2018 financial year. Over the decade, the annual rate for MUS implantation per 100 000 population halved from 78 to 36. Over this same period, the rate of usage of bulking agents doubled, although represented a low volume of procedures (overall numbers increased from 304 to 698, representing an increase from four to eight procedures per 100 000 population). The age-specific peak rate for MUS and Burch colposuspension changed over the decade from 55-64 years to 65-74 years, suggesting that women are deferring surgical treatment until later in life. Over the last decade, the total number of surgical procedures performed in Australia to treat SUI has decreased markedly from 6812 to 4279. This represents a decrease in the annual rate per 100 000 population from 93 to 49. CONCLUSIONS There are clear changes evident for SUI management in the past decade in Australia, including an overall decline in operative numbers, which correlate with international advisory notifications and local investigations. The results of the Australian Senate inquiry, including removal of single-incision mini-slings, greater availability of patient resources, and greater regulation of SUI procedures, will probably have ongoing effects. Surgeons need to ensure that sufficient training and patient education continue in order to maintain appropriate access to treatment of SUI in the future.
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Affiliation(s)
| | - Rebecca Kippen
- School of Rural Health, Monash University, Bendigo, Vic., Australia
| | | | - Janelle Brennan
- Bendigo Health, Bendigo, Vic., Australia.,School of Rural Health, Monash University, Bendigo, Vic., Australia.,St Vincent's Hospital Melbourne, Fitzroy, Vic., Australia
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The impact of the 2011 US Food and Drug Administration transvaginal mesh communication on utilization of synthetic mid-urethral sling procedures. Int Urogynecol J 2020; 32:2227-2231. [PMID: 33206220 DOI: 10.1007/s00192-020-04597-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We sought to examine the change in utilization of the midurethral sling (MUS) for the treatment of stress urinary incontinence (SUI) after the 2011 US FDA communication regarding transvaginal mesh. METHODS This is a retrospective cohort study evaluating surgical utilization of MUS at a managed care organization of 4.5 million patients from 2008 to 2016. The primary outcome was the change in utilization of synthetic mesh MUS before and after the July 2011 FDA communication. Secondary outcomes were the changes in surgeon level MUS utilization. RESULTS MUS procedures decreased from 131 to 116 per 100,000 adult women with a decrease of 11.5% from 2010 to 2012. Year over year utilization of MUS was rapidly increasing (p < 0.01) prior the FDA communication from 116 (in 2008) to 131 (in 2010) per 100,000 women and then significantly declined (p < 0.01) after its release from 135 (in 2011) to 75 (in 2016) per 100,000 women (13% increase vs 44% decrease). The number of surgeons performing MUS increased (p < 0.01) from 172/year to 186/year from 2008 to 2010 (Table 1). This decreased (p < 0.01) from 183/year to 121/year from 2011 to 2016. CONCLUSIONS MUS for SUI drastically declined after the FDA communication. Despite the 2011 FDA communication concerning only transvaginal mesh for pelvic organ prolapse, there was a significant decrease in MUS with synthetic mesh utilization. Our findings support the importance of continued long-term outcome data regarding the safety and efficacy of MUS and highlight the impact of the FDA warning on MUS utilization.
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Current Overview of Surgical Options for Female Stress Urinary Incontinence. Int Neurourol J 2020; 24:222-230. [PMID: 33017893 PMCID: PMC7538288 DOI: 10.5213/inj.2040052.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/03/2020] [Indexed: 02/06/2023] Open
Abstract
Stress urinary incontinence (SUI) is a highly prevalent health condition that significantly impacts the quality of life. Traditional methods of treatment for SUI, such as pubovaginal sling and Burch colposuspension, have been replaced by the midurethral sling because of its high efficacy, low complication and morbidity rates, and short learning curve. Although multiple behavioral and operative treatments exist, midurethral slings are the gold standard for the treatment of SUI in women. However, several reports have raised concerns about complications caused by the synthetic mesh used in midurethral slings. Therefore, surgical treatment for SUI in women must be chosen with care, taking into account potential complications. Herein, we review the current safety issues pertaining to the use of meshes, the efficacy of traditional surgeries, old and new midurethral slings, and recent data comparing the efficacy and safety of different surgical options. This review is aimed at developing practical guidelines for choosing surgical options for women with SUI.
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6
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Dietz HP. Virtual issue on urogynaecology. Aust N Z J Obstet Gynaecol 2020; 59:755-756. [PMID: 31820443 DOI: 10.1111/ajo.13095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 10/16/2019] [Indexed: 11/29/2022]
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7
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King J. Real story behind transvaginal mesh. Intern Med J 2020; 50:527-529. [PMID: 32431034 DOI: 10.1111/imj.14831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/10/2020] [Indexed: 11/30/2022]
Abstract
Much of the debate over the use of transvaginal mesh for incontinence and prolapse has been conducted on social media, in the tabloid press and through a very public Senate inquiry. It has been a very emotionally charged debate with surgeons variously accused of scandalous behavior, financial impropriety, surgical experimentation and misogyny. What really happened, how did we get here and what can we learn from these complex events?
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Affiliation(s)
- Jenny King
- Pelvic Floor Unit, Westmead Hospital, Sydney, New South Wales, Australia
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Behnia-Willison F, Nguyen TT, Norbury AJ, Mohamadi B, Salvatore S, Lam A. Promising impact of platelet rich plasma and carbon dioxide laser for stress urinary incontinence. Eur J Obstet Gynecol Reprod Biol X 2020; 5:100099. [PMID: 32021973 PMCID: PMC6994399 DOI: 10.1016/j.eurox.2019.100099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 09/17/2019] [Accepted: 10/14/2019] [Indexed: 12/30/2022] Open
Abstract
Objectives To evaluate the safety, feasibility and efficacy of trans-vaginal fractional micro-ablative CO2 laser therapy in combination with platelet rich plasma (PRP) for the treatment of stress urinary incontinence (SUI) in women. Study design Participants with SUI underwent three sessions of transvaginal CO2 laser and PRP treatment, administered at 4-6-week intervals. Outcomes were assessed using the bladder function section of the Australian Pelvic Floor Questionnaire (APFQ). The primary outcome was changes in the participants’ symptoms of SUI. Secondary outcomes were related to general bladder function. Outcome differences from baseline (T1) to 3 months (T2) and 12 months (T3) were analysed using Wilcoxon signed-rank tests. Subjective verbal scales were used to assess the degree of pain associated with PRP injections and laser treatment. Results Sixty-two women with SUI were enrolled into this study. There were 66% (41/62) of participants who reported improved SUI symptoms from T1 to T2 (p < 0.001) and at T3, 62% (23/37) of patients reported improved SUI symptoms (p < 0.001). From T1 to T2, all bladder function variables were improved significantly (p < 0.002). At T3, significant improvements (p < 0.03) were maintained for all bladder function variables, except pad usage (p = 0.073). Conclusions Combining transvaginal fractional CO2 laser with PRP might be a beneficial treatment for SUI. It may have the potential to be a minimally-invasive and low-risk alternative to surgery, with reduced recovery time.
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Giarenis I, Malde S, Harding C, Robinson D, Gajewski J, Rahnamai M, Cardozo L. Do we need better information to advise women with stress incontinence on their choice of surgery? Report from the ICI-RS 2018. Neurourol Urodyn 2019; 38 Suppl 5:S98-S103. [PMID: 31821636 DOI: 10.1002/nau.24020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/02/2019] [Accepted: 03/04/2019] [Indexed: 11/06/2022]
Abstract
AIMS The regulatory warnings about the safety of the synthetic midurethral slings (MUS) had a significant effect on how patients and physicians approach surgical management of stress urinary incontinence (SUI). In this changing landscape, the purpose of this research Think Tank (TT) was to provide an update of the current knowledge about the safety and efficacy of SUI surgery, to review patient goals and expectations and to identify factors affecting the decision making for surgery. METHODS This is a consensus report of the proceedings of TT3: "Do we need better information to advise women with stress incontinence on their choice of surgery?" from the annual International Consultation on Incontinence-Research Society (ICI-RS), June 2018. RESULTS Despite the body of evidence supporting the continued use of MUS, the short follow-up of most of the studies and the lack of "real life" data regarding pain and sexual dysfunction make the development of recommendations challenging. Women with SUI are often happy to "trade" efficacy for a procedure with less associated morbidity and therefore it is not always the procedure with the highest success rate that is ultimately chosen. However, a number of factors influence treatment decision and there is limited evidence about what level of all these factors women are willing to tolerate for a given success rate, or how much success they are willing to trade for a lower complication rate. CONCLUSIONS The ICI-RS proposed research questions which may be able to assist in improving the counseling and management of women with SUI.
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Affiliation(s)
- Ilias Giarenis
- Department of Urogynaecology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Sachin Malde
- Department of Urology, Guy's Hospital, London, UK
| | | | - Dudley Robinson
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Jerzy Gajewski
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mohammad Rahnamai
- Department of Urology, Uniklinik RWTH Aachen, Aachen, Germany.,Department of Urology, Maastricht University, Maastricht, The Netherlands
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
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Carter E, Cartwright R. Surgical interventions for stress urinary incontinence. BMJ 2019; 365:l2350. [PMID: 31167751 DOI: 10.1136/bmj.l2350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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11
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Zacche MM, Mukhopadhyay S, Giarenis I. Changing surgical trends for female stress urinary incontinence in England. Int Urogynecol J 2018; 30:203-209. [DOI: 10.1007/s00192-018-3839-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/21/2018] [Indexed: 10/27/2022]
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Sudol NT, Dutta S, Lane F. An Internet-based survey to evaluate the comfort and need for further pubovaginal sling training. Int Urogynecol J 2018; 30:1173-1178. [PMID: 29971468 DOI: 10.1007/s00192-018-3695-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/11/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The pubovaginal sling (PVS) dates to the 1940s as an efficacious surgical treatment for stress urinary incontinence (SUI). Recently, it has been replaced by the midurethral sling (MUS). Since 2008, international regulatory agencies increased regulation and issued warnings on vaginal mesh for repair of pelvic organ prolapse (POP), which has led to increased scrutiny of the MUS. Thus, the need for surgical comfort with PVS is resurfacing. We sought to evaluate the surgical practice patterns among international urogynecologists for the treatment of SUI and identify whether a need and interest for more training exists. METHODS We developed a short, Internet-based survey for members of the International Urogynecological Association (IUGA). Descriptive analyses, binomial and multivariate logistic regressions were calculated to determine significant associations. RESULTS Among 556 members who responded to the survey, 72% did not offer PVS in practice. Among those who did, there was as significant relationship between offering PVS and practicing in the United States, board-certification in urogynecology, PVS exposure in training, increasing number of PVS performed during training, and comfort with PVS. Members interested in further PVS training were younger, less comfortable with PVS, performed fewer PVS, or had no exposure in training. CONCLUSION Most IUGA members do not offer PVS in clinical practice. As would be expected, members who performed more PVS in training and were more comfortable with PVS were likely to offer it to patients. Our results highlight a learning gap, especially among younger providers who are not comfortable with PVS and desire further training in this procedure.
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Affiliation(s)
- Neha T Sudol
- Department of Obstetrics and Gynecology, University of California, Irvine, 333 City Blvd. West, Suite 1400, Orange, CA, 92868, USA.
| | - Sonia Dutta
- Department of Obstetrics and Gynecology, University of California, Irvine, 333 City Blvd. West, Suite 1400, Orange, CA, 92868, USA
| | - Felicia Lane
- Department of Obstetrics and Gynecology, University of California, Irvine, 333 City Blvd. West, Suite 1400, Orange, CA, 92868, USA
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Gillam MH, Kerr M, Pratt NL, Lim R, Roughead EE. Mesh use in urogynaecological procedures between 2005 and 2016: An Australian cohort study. Aust N Z J Obstet Gynaecol 2018; 59:105-109. [PMID: 29926904 DOI: 10.1111/ajo.12838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/17/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are common conditions. The use of mesh in the surgical treatment of these conditions in Australia is unclear. AIM To examine the use of mesh in POP and SUI procedures in an Australian national cohort of older women. METHODS We conducted a population-based cohort study using data from the Australian Government Department of Veterans' Affairs (DVA) database. The cohort consisted of older women who had POP and SUI procedures between 1 July, 2005 and 31 December, 2016. Women who received mesh were identified by matching device billing codes with the Australian Government's Prosthesis List. RESULTS In total, 3129 women experienced 3472 hospitalisations for POP and SUI procedures, with 74% of the women aged 75 years and older. There were 2276 (66%) hospitalisations with single POP repairs, 608 (18%) with single SUI procedures and 588 (17%) with concomitant POP and SUI procedures. Mesh was used in 23% of single procedures for POP, in 89% of single procedures for SUI and in 90% of concomitant POP and SUI procedures. The use of mesh in POP procedures decreased from a peak of 33% in 2008 down to 8% by 2016, whereas the use of mesh in SUI procedures increased from 77% in 2006 to 91% by 2016. CONCLUSION Mesh was commonly used in SUI procedures, whereas use of mesh in POP repair was less common and the use decreased rapidly after 2011, when warnings about use of mesh in POP were first issued.
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Affiliation(s)
- Marianne H Gillam
- School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, Australia
| | - Mhairi Kerr
- School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, Australia
| | - Nicole L Pratt
- School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, Australia
| | - Renly Lim
- School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, Australia
| | - Elizabeth E Roughead
- School of Pharmacy and Medical Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, Australia
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Miller BJ, Seman EI, O'Shea RT, Hakendorf PH, Nguyen TTT. Recent trends in the management of pelvic organ prolapse in Australia and New Zealand. Aust N Z J Obstet Gynaecol 2018; 59:117-122. [PMID: 29920645 DOI: 10.1111/ajo.12835] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/15/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare current practice in the management of female pelvic organ prolapse in Australia and New Zealand with that in 2007, and assess the impact on practice of the withdrawal of Prolift® and Prosima® mesh kits in 2015. MATERIALS AND METHODS In early 2015, two invitations to participate in a survey, including a link to Surveymonkey, were emailed to 2506 Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) trainees and fellows. The online survey closely resembled a printed survey that was posted to RANZCOG trainees and fellows in 2007 and had additional questions relating to the impact of withdrawal of Prolift® and Prosima® products. RESULTS Four-hundred-and-three doctors participated, giving a response rate of 16%. Native tissue repair was the procedure of choice for primary and recurrent prolapse of the anterior and posterior vaginal wall. An implant was used to treat 45% of anterior recurrences and 25% of posterior recurrences. Vaginal hysterectomy and repair were the procedures of choice for uterovaginal prolapse. Sacrospinous hysteropexy was the uterine preservation procedure of choice, preferred by 41%. For post-hysterectomy vault prolapse, sacrospinous colpopexy and vaginal repair was preferred by 65% of respondents. Between 2007 and 2015, there was a substantial decrease in respondents' usage of implants across all indications except for midurethral slings and sacrocolpo/hysteropexy. Forty-two percent of respondents changed their practice as a result of Prolift® and Prosima® being withdrawn. CONCLUSION There is a trend toward increasing use of various native tissue prolapse repair procedures and midurethral slings, and less utilisation of transvaginal mesh for prolapse.
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Affiliation(s)
- Brendan J Miller
- Department of Obstetrics and Gynaecology, Saint Vincent's Hospital, Toowoomba, Australia
| | - Elvis I Seman
- Department of Obstetrics and Gynaecology, Flinders Medical Centre, Adelaide, Australia
| | - Robert T O'Shea
- Department of Obstetrics and Gynaecology, Flinders Medical Centre, Adelaide, Australia
| | - Paul H Hakendorf
- Clinical Epidemiology Unit, Flinders Medical Centre, Adelaide, Australia
| | - Tran T T Nguyen
- Department of Obstetrics and Gynaecology, Flinders Medical Centre, Adelaide, Australia
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Chang J, Lee D. Midurethral slings in the mesh litigation era. Transl Androl Urol 2017; 6:S68-S75. [PMID: 28791224 PMCID: PMC5522799 DOI: 10.21037/tau.2017.04.06] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 03/26/2017] [Indexed: 01/04/2023] Open
Abstract
Stress urinary incontinence (SUI) has always been a major health issue for women. With the progression of technology and surgical techniques, mid urethral slings (MUS) used in both transvaginal and transobturator routes have become the gold standard in the treatment of SUI. There is ample short to mid-term data confirming the efficacy and safety in using MUS in treating SUI in women. However, long-term data supporting the use of MUS in women to treat SUI is scarce. There has been much controversy surrounding the US Food and Drug Administrations' (FDA) public notification of potential complications surrounding the use of transvaginal mesh, which has been magnified and generalised by the media; but despite this there has still been substantial growth and uptake of MUS for treating SUI. In this review, we aim to explore some of the issues with MUS, the factors around litigation with mesh use, the impact of FDA's notification on the uptake of MUS and ultimately, the results and efficacy of MUS for the treatment of SUI.
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Affiliation(s)
- John Chang
- Department of Urology, St George Hospital, Kogarah, Australia
| | - Dominic Lee
- Department of Urology, St George Hospital, Kogarah, Australia
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16
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Surgical Treatment of Female Stress Urinary Incontinence: Do Tapes Stand the Test of Time? Eur Urol 2017; 72:592-593. [PMID: 28528813 DOI: 10.1016/j.eururo.2017.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/05/2017] [Indexed: 11/24/2022]
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