OB-GYN-L Messages for May, 2005: Fwd: Mesh for AP repair

Fwd: Mesh for AP repair

From: R. Daniel Braun

rd.braun@gmail.com

Thu May 26 12:20:27 2005

hi dan, this is a great question and i'm afraid i can't do it justice in an email, but i'll make a few comments. to date, there are high erosion rates reported when mesh is placed vaginally. two studies with small numbers (one is tony visco from duke, the other is tom julian) showed erosion rates of between 25-40%. this was using a polypropylene mesh and marlex mesh respectively. studies out of europe are now appearing using new, lighter polypropylene meshes. they claim to have an erosion rate of around 10-12% when placed to augment tissue during a vaginal repair. although this is much lower, it is still a major problem and difficult to take care of once it occurs. if only a small piece of mesh is visible, it can be trimmed in the office and the patient treated with an antibiotic cream for 1 week (cleocin or metrogel) followed by estrogen cream. if a decent mesh was placed, this may take care of the problem. if an unacceptable mesh was placed (Gore-tex, multifilament, braided, etc.) it may have to be removed in its entirety to correct the problem. choosing a mesh with good characteristics and properly picking the patients (healthy vaginal tissue, well estrogenized, good blood supply) will help decrease the erosions. unfortunately, based on the success of tvt, industry is trying to push kits for prolapse that involve mesh placement. ams and gynecare are now marketing kits that have very little data and no controlled studies. in my opinion, these devices need much more data and should be left to research centers until we truly know the answers. the risk of erosion into bladder and bowel is also a real problem when the wrong mesh is placed in the wrong patient. we have not learned from some of our past experiences when just a few years ago, a company trying to cash in on the success of tvt came out with a sling. protegen was its name and it is now off the market due to its numerous complications. anyone who knows about mesh knew this was a bad product -- it was a multifilament, braided material (both associated with high erosion, infection rates) coated with collagen. it got fda approval and now is involved in numerous law suits with hundreds of physicians being named. it was a case of industry pushing a product without appropriate data -- much like these current kits. they may prove to be a viable solution in some patients, but its much too early to tell. i would certainly wait to have this data before exposing the patient (and physician) to these risks. i hope that helps. doug Douglass S. Hale. M.D., FACOG Director Female Pelvic Medicine and Reconstructive Surgery Fellowship Associate Clinical Professor Indiana University/ Methodist Hospital

-----Original Message----- ---------- Forwarded message ---------- From: Andrew Folley <agfolley@hotmail.com> Date: May 26, 2005 9:22 AM Subject: Re: Mesh for AP repair To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>

Is anyone using synthetic mesh for their AP repairs. I have a lady 10 weeks post op with VH and AP repair and the mesh is showing through on her posterior repair along the midline. She is asymptomatic and I am wonderning if I can jsut leave it alone or if it will lead to long term problems???? Any experiences??? Andrew

-- R. Daniel Braun Kinky for Governor

--
R. Daniel Braun
Kinky for Governor

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