ICS NEWS: What is the “prospect” of primary anterior and posterior prolapse surgery? The introduction of synthetic mesh and biological grafts in vaginal prolapse surgery was a direct consequence of the poor surgical outcomes highlighted in numerous studies over the past two decades.
Evidence from the 2016 Cochrane systematic review on the safety and effectiveness of surgery for anterior and posterior compartment prolapse suggested that, while permanent mesh provides minimal advantage compared with native tissue repair with regards to awareness of prolapse and staging of prolapse on examination, it is associated with higher rates of reoperation for prolapse, stress urinary incontinence or mesh exposure and increased risk of bladder injury at surgery. It also highlighted the lack of evidence regarding the potential advantages of biological grafts over native tissue repair. Additional Information Article by Alexandros Derpapas on behalf of the Publication and Communications Committee. ACOG Guidelines: Urinary Incontinence in Women.
ACOG Guidelines: Urinary Incontinence in Women. Behavior and lifestyle modifications The ACOG guideline emphasizes the importance of behavioral and lifestyle modifications including bladder training, weight loss, and dietary management.
SUI is highly associated with obesity, and weight loss not only has been shown to reduce and resolve incontinence but also has many other obvious benefits. Voiding diary information and institution of appropriate fluid management, especially for the many women who drink excessive amounts of fluid, may resolve complaints in some cases. For example, a woman who takes her Lasix and then gets into her car for an hour-long commute to work only to leak trying to get to the bathroom can be told to take her diuretic at a different time.
The time-honored practice of pelvic muscle exercises is also discussed, and giving appropriate instructions, particularly about when to use muscle contraction to prevent urine leakage, can make a substantial difference for many women. Medications Surgical management Reference 1. Preliminary_program_final. Blogs : Midurethral Slings: A Treatment Worth Protecting. Dear AUGS Members, The FDA had readied us for issues with vaginal mesh in their 2008 and 2011 Safety Statements.
However, what we didn’t anticipate was how unpredictable juries would respond to trials involving sling law suits. In the face of overwhelming evidence supporting the most studied procedure in the history of incontinence treatments, polypropylene midurethral slings now find themselves caught in the crosshairs of our legal system. The recent settlements doled out have caused companies producing slings to take a hard business look at whether the bad publicity and large sums of money involved with these cases are worth their time, investment, and energy. As we are all now aware, ASTORA (formerly AMS) has answered this question for themselves with their announcement in the Wall Street Journal earlier this week. AUGS has been in contact with other industry partners who assure us, they are not going to abandon the sling market. Sincerely, Douglass Hale, MD AUGS President. The mess with the mesh - EAU16 Munich.
“For the first time, we are establishing some firm rules for mesh use, which can only be a good thing for the safety of patients.”
This was one of the hopeful conclusions of Prof. Stefano Salvatore (IT), gynaecologist and President of the European Association of Urogynaecology. On Sunday morning, Prof. Salvatore gave a well-received state-of-the-art lecture as part of Thematic Session 7: challenges in incontinence treatment. Prof. “Taken all together, this brought a huge reaction against meshes from the patients themselves. Recent attention to the dangers of mesh use (including reclassifications from the FDA from Class II to Class III, or high-risk) has reached a peak because complications aren’t immediately clear. Do we still need meshes for correction of pelvic organ prolapse? - EAU16 Munich. Pelvic organ prolapse (POP) is an increasingly common female health problem which, when symptomatic, has a significant negative impact on all aspects of daily life.
Treatment is commonly surgical and should aim not only at restoring anatomy but also at alleviating symptoms, improving long-term pelvic organ function. The etiology of POP is multifactorial. The end-result, nevertheless, is an inadequate pelvic organ support system. Emerging evidence suggests even a genetic linkage to supporting tissue defects in women with POP.
The poor condition of these tissues at the time of surgical intervention provides the rationale for the use of mesh to reinforce repairs. This article will focus on recent evidence on the pros and cons of using synthetic meshes in POP repairs. Reasons for using a mesh. Semaine de la continence 2016. 11-15 March 2016. UGSA_2016_ASM_Program_Final. Annual Meeting. DocumentsDownload. OASIS. OASIS. OASIS. OASIS. OASIS. Syllabus26_6b.