Comparative analyses of attitude, knowledge, and recollection of preoperative counseling regarding pelvic mesh among women with or without a mesh-related complication

Pain and other complications of pelvic mesh: a systematic review of qualitative studies and thematic synthesis of women's accounts

OBJECTIVES

Synthesis of the experience of women with pain from pelvic or vaginal mesh or its removal, to identify pain-related problems and to formulate psychological aspects of pain.

DESIGN

Systematic review and thematic analysis of qualitative studies of pain from pelvic or vaginal mesh, or mesh removal, in women over 18 years, using individual interviews, focus groups, free text, or written or oral contributions to formal enquiries.

DATA SOURCES

Medline, Embase and PsycINFO, from inception to 26 April 2023.

ELIGIBILITY CRITERIA

Qualitative studies of pain and other symptoms from pelvic or vaginal mesh or its removal; adults; no language restriction.

DATA EXTRACTION AND SYNTHESIS

Line-by-line coding of participant quotations and study author statements by one author to provide codes that were applied to half the studies by another author and differences resolved by discussion. Codes were grouped into subthemes and themes by both authors, then scrutinised and discussed by a focus group of mesh-injured women for omissions, emphasis and coherence. Studies were appraised using an amalgamation of the CASP and COREQ tools.

RESULTS

2292 search results produced 9 eligible studies, with 7-752 participants, a total of around 2000. Four recruited patients, four totally or partially from mesh advocacy groups, and two were national enquiries (UK and Australia). Four major themes were as follows: broken body, broken mind; distrust of doctors and the medical industry; broken life and keeping going-a changed future. Psychological content mainly concerned the loss of trust in medical care, leaving women unsupported in facing an uncertain future. Mesh-injured women strongly endorsed the findings.

CONCLUSIONS

Pain and other problems associated with pelvic mesh are profound and far-reaching for women affected. Worse, they feel subject to continued gaslighting, including denial of their mesh-related problems and dismissal of their concerns about continued mesh insertion.

PROSPERO REGISTRATION NUMBER

CRD42022330527.

Aversion to Mesh Use in Pelvic Floor Surgery in a Latina Population at the U.S.-Mexico Border

IMPORTANCE

Limited studies have examined patient aversion to mesh use in pelvic surgery, especially in Latinas.

OBJECTIVE

This study aimed to assess aversion to pelvic surgery with mesh for urinary incontinence and pelvic organ prolapse in a sample of Latinas on the U.S.-Mexico border.

STUDY DESIGN

This was a cross-sectional study of self-identified Latinas with symptoms of pelvic floor disorders, recruited at their initial consultation visit at a single, academic urogynecology clinic. Participants completed a validated survey to assess perceptions of mesh use in pelvic surgery. Participants also completed questionnaires assessing the presence and severity of pelvic floor symptoms and level of acculturation. The primary outcome was aversion to mesh surgery, as indicated by a response of "yes" or "maybe" to the question "Based on what you already know, would you avoid surgery using mesh?" Descriptive analysis, univariate relative risk, and linear regression analysis were completed to identify characteristics associated with mesh avoidance. Significance was assessed and considered at P values <0.05.

RESULTS

Ninety-six women were included. Only 6.3% had prior pelvic floor surgery using mesh. Sixty-six percent indicated that they would be likely to avoid pelvic surgery that uses mesh. Only 9.4% indicated that they obtained information regarding mesh directly from medical professionals. Levels of concern regarding the use of mesh varied widely (29.2% not worried, 19.1% somewhat worried, 16.9% very worried). Higher percentages of "more acculturated" participants indicated a desire to avoid mesh surgery (58.7% vs 27.3%, P < 0.05).

CONCLUSIONS

In this Latina population, a majority of patients indicated an aversion to using mesh in pelvic surgery. Few patients obtained information regarding mesh directly from medical professionals, relying instead on nonmedical sources.

A Randomized Controlled Trial Evaluating the Effect of an Educational Video on Patient Understanding of Midurethral Sling

OBJECTIVE

The primary objective was to evaluate the use of a novel video for enhancing patient knowledge of midurethral sling compared with standard handout.

METHODS

Participants scheduled for midurethral sling were randomized to 1 of 2 preoperative educational interventions, either video or standard handout. The primary outcome was change in knowledge measured via a 15-question questionnaire completed immediately before and after the intervention. Secondary outcomes were knowledge retention, urinary symptoms, decision satisfaction, and regret measured via validated questionnaires at 2 and 6 weeks postoperatively. Data are presented as median (interquartile range) and comparisons between intervention groups made using non-parametric statistics. A sample size of 16 per arm was calculated to detect a 20% effect size.

RESULTS

Thirty-eight participants, 19 per site, were randomized from August 2019 to October 2020 and 37 (97%) completed the primary outcome per protocol. Median age was 51 years (18 years), and there were no significant demographic differences between groups. Participants randomized to video demonstrated greater change in knowledge than those randomized to handout (+8.5 (3) vs +2.0 (4), P < 0.0001). Those randomized to video demonstrated improved 6 week postoperative urinary symptoms (Urogenital Distress Inventory-6, 0.0 [8.3] vs 14.6 [26.0]; P = 0.02; Incontinence Severity Index, 0.0 [2] vs 3.0 [4]; P = 0.005). There were no differences in satisfaction with decision (5.0 [0] video vs 5.0 [0.9] handout; P = 0.48) or decision regret (1.0 [0.5] video vs 1.0 [0.8] handout; P = 0.80) at 6 weeks postoperatively.

CONCLUSIONS

A preoperative educational video improved knowledge and urinary symptoms after midurethral sling compared with a standard handout.