Re: Fwd: Mesh for AP repair
From: Andrew Folley (agfolley@hotmail.com)
Thu May 26 13:13:45 2005
Dan
Thanks for getting Dougs input. (and others input on hte mesh issue). andy
>From: "R. Daniel Braun" <rd.braun@gmail.com>
>Reply-To: ob-gyn-l@obgyn.net
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>Subject: Fwd: Mesh for AP repair
>Date: Thu, 26 May 2005 12:22:08 -0500
>
>Hey group,
>I forwarded Andy's question to Doug Hale the director of our Urogyn
>Fellowship. Here is his response.
> Dan
>
> 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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