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Garcia C, Homewood D, Gani J, O'Connell HE. Perspectives on technology: urethral slings in a post-mesh world. BJU Int 2024. [PMID: 38822540 DOI: 10.1111/bju.16388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
OBJECTIVES To detail the history of synthetic mid-urethral slings (SMUSs) and fascial slings, their efficacy, associated complications, and changes to practice that have occurred after the issuing of the 2011 US Food and Drug Administration (FDA) Safety Communication statement on transvaginal mesh (TVM), and to highlight the need for surgical registries and high-quality randomised controlled data to guide recommendations for continence procedures, in view of current concerns regarding mesh. METHODS A literature search was conducted in EMBASE, PubMed, and the Cochrane Database of systematic reviews to identify articles published from 2011 onward, following the FDA Safety Communication regarding TVM. RESULTS Prior to the formal FDA Safety Communication in 2011, TVM was considered a safe option for the treatment of both pelvic organ prolapse (POP) and stress urinary incontinence (SUI). The 2011 FDA safety communications and ensuing widely publicised litigation against TVM manufacturers have shifted both surgeon and patient acceptance of mesh products. Several efforts by medical and government bodies have been made to establish ways to monitor the surgical outcomes and safety of mesh products. The Australasian Pelvic Floor Procedure Registry is one such example. Although SMUSs have a long and established safety profile, perceptions of mesh products for SUI have also been negatively affected. The extent of this, however, has yet to be adequately measured through qualitative and quantitative data. The available data suggest it has been difficult for patients and consumers to distinguish between TVM morbidity for POP vs SUI. Furthermore, there remains a lack of high-quality randomised or real-world registry data to definitively exclude the SMUS from the SUI treatment algorithm. Since SMUSs are a viable option for SUI treatment, the concept of a 'post-mesh world' remains contentious. CONCLUSION Controversies surrounding SMUSs have changed the treatment landscape of SUI. Against the background of significant litigious action following the FDA warnings against mesh use, there has been significant reduction in the uptake of synthetic mesh products. Although there are ample data related to surgical outcomes and safety for both autologous fascial and retropubic SMUSs in carefully selected patients, informed consent and surgical training will be of paramount importance as newer synthetic materials reach clinical maturity.
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Affiliation(s)
- Cindy Garcia
- North Shore Private Hospital, Sydney, NSW, Australia
| | - David Homewood
- Department of Urology, Western Health, Melbourne, VIC, Australia
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
- International Medical Robotics Academy, Melbourne, VIC, Australia
| | - Johan Gani
- Department of Urology, Western Health, Melbourne, VIC, Australia
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
- Epworth Healthcare, Melbourne, VIC, Australia
| | - Helen E O'Connell
- Urological Society of Australia and New Zealand, Edgecliff, NSW, Australia
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
- Epworth Healthcare, Melbourne, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC, Australia
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Florence E, Limtrakul N, Sanchez S, Montoya TI, Maldonado PA. Aversion to Mesh Use in Pelvic Floor Surgery in a Latina Population at the U.S.-Mexico Border. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:17-25. [PMID: 37326237 DOI: 10.1097/spv.0000000000001375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
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.
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Affiliation(s)
- Elizabeth Florence
- From the Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX
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Mollah T, Brennan J. Australian trends in the treatment of pelvic organ prolapse in the non-mesh era. ANZ J Surg 2023; 93:469-475. [PMID: 36629143 DOI: 10.1111/ans.18268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/11/2022] [Accepted: 12/31/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND To assess the contemporary trends in the types and incidence of pelvic organ prolapse (POP) surgery in Australia after the removal of transvaginal mesh from the Australian market. METHODS This was a retrospective Australian cohort study utilizing three large Governmental databases covering all private and public POP procedures in Australia. All females ≥25 years old undergoing POP procedures between 2005 and 2021 were included. RESULTS From 2005-2006 to 2020-2021 there have been a total of 408 881 POP procedures in Australia. The total number of procedures peaked in 2005-2006 at 537.8 procedures per 100 000 age-standardized female population, decreasing by an average of 3.5% per year to 329.0 procedures per 100 000 in 2018-2019, an overall 38.8% decrease (P < 0.001). A sudden growth in private operative procedures was noted between 2019-2020 and 2020-2021, from 218.2 to 268.6 procedures per 100 000 population, a 23.1% increase (P < 0.001). Laparoscopic and abdominal POP repair has seen a 115.8% increase from 13.7 procedures to 29.6 per 100 000 between 2005-2006 and 2020-2021. Over the last 15 years, the most common age group to undergo a procedure has changed from the 55 to 64 years demographic to a later decade of 65 to 74 years. CONCLUSION Over the last 15 years, the total number of POP procedures performed has significantly decreased. There has however been a recent rise in interventions seen in the private sector and the utilization of laparoscopic or abdominal POP repair has increased, which has implications for procedural credentialing to ensure patient safety.
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Affiliation(s)
- Taha Mollah
- Department of Surgery, St. Vincent's Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Swan Hill Hospital, Swan Hill, Victoria, Australia
| | - Janelle Brennan
- Department of Urology, Bendigo Health, Bendigo, Victoria, Australia
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Exosome biopotentiated hydrogel restores damaged skeletal muscle in a porcine model of stress urinary incontinence. NPJ Regen Med 2022; 7:58. [PMID: 36175423 PMCID: PMC9523025 DOI: 10.1038/s41536-022-00240-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/05/2022] [Indexed: 11/28/2022] Open
Abstract
Urinary incontinence afflicts up to 40% of adult women in the United States. Stress urinary incontinence (SUI) accounts for approximately one-third of these cases, precipitating ~200,000 surgical procedures annually. Continence is maintained through the interplay of sub-urethral support and urethral sphincter coaptation, particularly during activities that increase intra-abdominal pressure. Currently, surgical correction of SUI focuses on the re-establishment of sub-urethral support. However, mesh-based repairs are associated with foreign body reactions and poor localized tissue healing, which leads to mesh exposure, prompting the pursuit of technologies that restore external urethral sphincter function and limit surgical risk. The present work utilizes a human platelet-derived CD41a and CD9 expressing extracellular vesicle product (PEP) enriched for NF-κB and PD-L1 and derived to ensure the preservation of lipid bilayer for enhanced stability and compatibility with hydrogel-based sustained delivery approaches. In vitro, the application of PEP to skeletal muscle satellite cells in vitro drove proliferation and differentiation in an NF-κB-dependent fashion, with full inhibition of impact on exposure to resveratrol. PEP biopotentiation of collagen-1 and fibrin glue hydrogel achieved sustained exosome release at 37 °C, creating an ultrastructural “bead on a string” pattern on scanning electron microscopy. Initial testing in a rodent model of latissimus dorsi injury documented activation of skeletal muscle proliferation of healing. In a porcine model of stress urinary incontinence, delivery of PEP-biopotentiated collagen-1 induced functional restoration of the external urethral sphincter. The histological evaluation found that sustained PEP release was associated with new skeletal muscle formation and polarization of local macrophages towards the regenerative M2 phenotype. The results provided herein serve as the first description of PEP-based biopotentiation of hydrogels implemented to restore skeletal muscle function and may serve as a promising approach for the nonsurgical management of SUI.
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Shaw JS, Gerjevic KA, Pollack C, Strohbehn K. Minimally Invasive Autologous Fascia Sling at the Midurethra: A Case Series. J Minim Invasive Gynecol 2022; 29:1165-1169. [PMID: 35809894 DOI: 10.1016/j.jmig.2022.07.001] [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: 04/05/2022] [Revised: 06/03/2022] [Accepted: 07/01/2022] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE The primary objective was to determine the improvement in stress urinary incontinence symptoms using autologous fascia lata sling placed at the midurethra. The secondary objective was to determine the presence of leg pain after harvest of fascia lata graft. DESIGN Case series. SETTING Rural academic tertiary care center. PATIENTS All women who underwent an autologous fascia midurethral sling over a 1-year period between June 2019 and September 2020. INTERVENTIONS Autologous fascia lata midurethral sling. MEASUREMENTS Incontinence severity index, urodynamic distress inventory-6, and Likert pain scale. MAIN RESULTS Nineteen women received an autologous fascial sling at the midurethra using the described technique-16 fascia lata and 3 rectus fasciae. Mean improvement in incontinence severity index score was 6 points. Mean improvement in urodynamic distress inventory-6 and SUI subscale scores was 14 and 53, respectively, surpassing the minimally important difference for each. Median follow-up time was 9 months (range 2-16). Leg pain at the harvest site was bothersome in 1 patient beyond 6 weeks. Median time to passing voiding trial was 4 days (range 1-13 days). Four patients (21%) had postoperative voiding dysfunction, 3 of which resolved after sling loosening at a mean of 60 days after sling placement. CONCLUSION Midurethral autologous fascial sling placement significantly improves symptoms of SUI but carries a risk of voiding dysfunction. Harvesting fascia lata using a fascial stripper is associated with minimal postoperative morbidity.
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Affiliation(s)
- Jonathan S Shaw
- Division of Urogynecology, Department of Obstetrics & Gynecology, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon (Drs. Shaw, Gerjevic, and Strohbehn).
| | - Kristen A Gerjevic
- Division of Urogynecology, Department of Obstetrics & Gynecology, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon (Drs. Shaw, Gerjevic, and Strohbehn)
| | - Catherine Pollack
- Departments of Biomedical Data Science and Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover (Ms. Pollack), New Hampshire; Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover (Ms. Pollack), New Hampshire
| | - Kris Strohbehn
- Division of Urogynecology, Department of Obstetrics & Gynecology, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon (Drs. Shaw, Gerjevic, and Strohbehn)
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Perceptions of Mesh Use for Pelvic Floor Surgery in Latinas: Face Validity of a Spanish Questionnaire. Female Pelvic Med Reconstr Surg 2021; 27:163-169. [PMID: 33620899 DOI: 10.1097/spv.0000000000001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the study was to validate a Spanish-translated survey assessing patients' perceptions of mesh use in pelvic floor surgery. METHODS An English-language survey evaluating perceptions of mesh use underwent a process of Spanish translation and validation, using a forward-backward translation validation protocol. Self-identified bilingual Latinas with symptoms of pelvic floor disorders were recruited to participate in cognitive interviews after completing the survey in English and Spanish. κ coefficient and Cronbach α were calculated for measurement of reliability and internal consistency in responses. A P value of 0.05 was considered statistically significant. RESULTS A total of 30 women were randomized to complete the initial survey in either English or Spanish. Demographics for the 2 cohorts were similar. For the Spanish-translated survey overall, 86% described the questions as "somewhat easy" or "very easy" to understand, and 93% reported that it was "clear" or "very clear" that the survey aimed to investigate their thoughts regarding mesh use. Approximately 63% of the participants expressed confusion over the use of the Spanish medical term "cabestrillo," translated for "sling." There were no significant differences in the responses on cognitive interview between the 2 groups. Overall, the responses between English and Spanish versions of the survey demonstrated good reliability and internal consistency. CONCLUSIONS This study demonstrated face validity of a Spanish-translated survey assessing perceptions of mesh use in pelvic surgery in a Latina population. Participants' feedback was crucial to optimizing the quality of the survey for future studies that will evaluate Spanish-speaking patients' views of mesh implants in pelvic reconstructive surgery.
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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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Siegal AR, Huang Z, Gross MD, Mehraban-Far S, Weissbart SJ, Kim JM. Trends of Mesh Utilization for Stress Urinary Incontinence Before and After the 2011 Food and Drug Administration Notification Between FPMRS-Certified and Non-FPMRS-Certified Physicians: A Statewide All-Payer Database Analysis. Urology 2020; 150:151-157. [PMID: 32663554 DOI: 10.1016/j.urology.2020.06.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/22/2020] [Accepted: 06/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To investigate the utilization of mesh slings for stress urinary incontinence (SUI) across time - before and after the 2011 US Food and Drug Administration (FDA) public health notification regarding an increase in adverse events related to transvaginal mesh (TVM) for pelvic organ prolapse (POP) repair - and among FPMRS-certified urologists and gynecologists and non-FPMRS counterparts using a statewide database. METHODS The New York Statewide Planning and Research Cooperative System all-payer database was utilized to extract outpatient Current Procedural Terminology procedure codes for SUI mesh sling utilization and revision or removal performed between 2007 and 2015. RESULTS After the 2011 FDA warning on POP with TVM, sling placement decreased by 43% from 5214 cases in 2011 to 2958 in 2015. However, over the study period, the rate of sling revision remained stable relative to total sling placement. The rise and fall in mesh sling usage for SUI was primarily driven by non-FPMRS providers. FPMRS providers performed a higher proportion of sling procedures. The number of FPMRS physicians also increased from 2011 to 2015, and each individual physician had a higher median case volume for sling placements and revisions. CONCLUSION In New York state, utilization of mesh slings for SUI has significantly decreased since the 2011 FDA public health notification, without any specific warning for the utilization of mesh in this setting. This trend was mainly driven by a decrease in mesh usage among non-FPMRS physicians, although the specific causality is likely complex.
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Affiliation(s)
- Alexandra R Siegal
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY.
| | - Zhenyue Huang
- Department of Urology, Stony Brook University Medical Center, Stony Brook, NY
| | - Michael D Gross
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Sina Mehraban-Far
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Steven J Weissbart
- Department of Urology, Stony Brook University Medical Center, Stony Brook, NY
| | - Jason M Kim
- Department of Urology, Stony Brook University Medical Center, Stony Brook, NY
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Temporal Trends of Urogynecologic Mesh Reports to the U.S. Food and Drug Administration. Obstet Gynecol 2020; 135:1084-1090. [DOI: 10.1097/aog.0000000000003805] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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AlMarzooqi R, Petro C, Tish S, Fafaj A, Alkhatib H, Tastaldi L, Tu C, Prabhu A, Krpata D, Rosen M. Patient perceptions on mesh use in hernia repair: A prospective, questionnaire-based study. Surgery 2020; 167:751-756. [PMID: 32061401 DOI: 10.1016/j.surg.2019.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/22/2019] [Accepted: 12/06/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND There has been increasing media coverage regarding the controversy of using mesh in various operations. At this time, there are no published studies evaluating the potential influence of this controversy on patients' perceptions. Therefore, our study aimed to assess patient perceptions of hernia repair surgery with mesh as well as factors that may influence patient opinions. METHODS A 16-item questionnaire evaluated each patient's perceptions of the use of mesh in their upcoming hernia repair. The primary outcomes of interest were their level of comfort regarding the possibility of hernia repair surgery with mesh, aversion to hernia surgery with mesh, and positive belief that mesh is a safe product in hernia repair surgery. RESULTS We included 100 patients presenting for a hernia repair and 100 patients presenting for other operations. Both groups identified the media as their most common influence (37% and 40%, respectively). Factors leading to a high level of comfort regarding the possibility of mesh repair included believing mesh was a safe product (P < .001) and hearing about the advantages of mesh (P = .012) from medical professionals (P = .001). Factors leading to a positive belief that mesh was a safe product included the male sex (P = .015), a high socioeconomic standing (P = .006), and their own personal experience (P = .013). Factors leading to aversion to mesh use included the female sex (P = .006) and hearing about meshes causing mesh-related (P = .028) and wound-related complications (P = .025) as well as chronic pain (.008). CONCLUSION Despite the high penetration of non-medical information in the population before presentation for medical care, most patients overall do not seem to be opposed to the concept of the use of mesh in a hernia repair, but there are certain factors associated with aversion to the use of mesh that physicians should acknowledge and should address this potential issue.
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Affiliation(s)
- Raha AlMarzooqi
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, OH.
| | - Clayton Petro
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, OH
| | - Shahed Tish
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, OH
| | - Aldo Fafaj
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, OH
| | - Hemasat Alkhatib
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, OH
| | - Luciano Tastaldi
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, OH
| | - Chao Tu
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, OH
| | - Ajita Prabhu
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, OH
| | - David Krpata
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, OH
| | - Michael Rosen
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, OH
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Kaufman MR. Contemporary application of autologous muscle-derived cells for urinary sphincter regeneration. World J Urol 2019; 38:2095-2099. [DOI: 10.1007/s00345-019-03018-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/07/2019] [Indexed: 12/24/2022] Open
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Making surgery safer through adequate communication with the stakeholders: vaginal slings. World J Urol 2019; 38:1351-1358. [PMID: 31273442 DOI: 10.1007/s00345-019-02859-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/24/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE In this review, we explore the evidence behind mid-urethral sling (MUS) surgery, review the rising reports of complications and the subsequent US Food and Drug Administration (FDA) and society statements, and evaluate risk perception and communication with patients, doctors, governing bodies, manufacturers and insurance companies. Our aim was to explore the pitfalls in communication that may be contributing to the decline in MUS use, and develop strategies to make MUS surgery safer. METHODS We searched the English language literature using PubMed for articles related to the management of stress urinary incontinence (SUI), MUS, safety and monitoring of transvaginal mesh (TVM), and reviewed all online FDA publications and international position statements regarding MUS for SUI. RESULTS Polypropylene mesh has been used in MUS since the 1990s, with robust evidence to support its use. There has been a decline in the use of MUS ever since the FDA notifications. In response to the controversy surrounding TVM, position statements have been released portending the safety of, and advocating for the continued use of, MUS for the management of SUI. CONCLUSIONS MUS is a viable, effective and safe treatment for SUI management. Physicians should obtain and document informed consent, be adequately trained, and monitor and report their outcomes using registries. With publication of registry results and ongoing health advocacy, the perception of the safety of MUS can improve and MUS can still be offered as a treatment option for SUI.
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Palmerola R, Peyronnet B, Rebolos M, Khan A, Sussman RD, Escobar C, Smith S, Rosenblum N, Nitti VW. Trends in Stress Urinary Incontinence Surgery at a Tertiary Center: Midurethral Sling Use Following the AUGS/SUFU Position Statement. Urology 2019; 131:71-76. [PMID: 31229514 DOI: 10.1016/j.urology.2019.04.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate trends in stress urinary incontinence (SUI) surgery before and after the 2011 Foods and Drug Administration notification and the 2014 (American Urogynecologic Society [AUGS]/Society for Urodynamics Female Pelvic Medicine and Urogenital Reconstruction [SUFU]) position statement. METHODS A retrospective chart review was performed to identify patients presenting for evaluation of SUI by 2 Female Pelvic Medicine and Reconstructive Surgery specialists between June 1, 2010 and May 31, 2017. Rates of surgical treatment modality (synthetic midurethral slings [MUS] versus autologous fascial pubovaginal sling versus bulking agents) were analyzed at 6-month intervals. RESULTS Over fourteen 6-month intervals, the number of new patients presenting for evaluation of SUI increased consistently. There was a decrease in the proportion of new patients who underwent antiincontinence surgical procedures, specifically MUS, between December 2011 and December 2013. After the integration of the 2014 AUGS/SUFU position statement in patient counseling, this trend reverted and we noted a sustained increase in the proportion of patients electing surgical management. This paralleled an increase in new patient visits for SUI and MUS. The number autologous fascial pubovaginal sling remained stable throughout the study period. Conversely, MUS composed the highest proportion of procedures performed, accounting for 60 %-87.2% off all antiincontinence procedures. CONCLUSION After the Foods and Drug Administration Public Health Notification in 2011, we observed a decline in the number of new patients presenting with SUI electing surgical management, specifically MUS. However, after the AUGS/SUFU position statement publication and integration into counseling, we observed a reversal in the previous year's trends, noting a resurgence of MUS utilization.
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Affiliation(s)
- Ricardo Palmerola
- Departments of Urology and Obstetrics & Gynecology, New York University, New York, NY.
| | - Benoit Peyronnet
- Departments of Urology and Obstetrics & Gynecology, New York University, New York, NY
| | - Mark Rebolos
- Departments of Urology and Obstetrics & Gynecology, New York University, New York, NY
| | - Aqsa Khan
- Department of Urology, Mayo Clinic, Phoenix, AZ
| | - Rachael D Sussman
- Departments of Urology and Obstetrics & Gynecology, New York University, New York, NY
| | - Christina Escobar
- Departments of Urology and Obstetrics & Gynecology, New York University, New York, NY
| | | | - Nirit Rosenblum
- Departments of Urology and Obstetrics & Gynecology, New York University, New York, NY
| | - Victor W Nitti
- Departments of Urology and Obstetrics & Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Mohamoud M, Patanavanich S, Crew P, McCulley L, Munoz M, Kortepeter C, Jones SC, Woronow D, Dal Pan G. Discontinuation of Direct Oral Anticoagulants in Response to Attorney Advertisements: Data From the FDA Adverse Event Reporting System. Ann Pharmacother 2019; 53:962-963. [DOI: 10.1177/1060028019849664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Autologous Muscle-Derived Cells for Urinary Sphincter Regeneration: Where are we now? CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0486-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Li ALK, Lee PE. The Effect of Medical Consultation on Patients' Concerns Regarding Vaginal Mesh Use in Pelvic Reconstructive Surgery. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 41:174-179. [PMID: 30482730 DOI: 10.1016/j.jogc.2018.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/13/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study sought to determine patients' background knowledge and attitudes towards the use of mesh in pelvic floor reconstructive surgery (PFRS) and the effect of medical consultation on their knowledge and attitudes about mesh use. METHODS New urogynecology patients seen for pelvic organ prolapse and/or stress urinary incontinence were asked to complete pre-consultation questionnaires involving 12 questions on demographics and knowledge, attitudes, and concerns about the use of vaginal mesh. If PFRS was discussed, a post-consultation questionnaire was administered. RESULTS A total of 202 new patients were surveyed. Of these patients, 73.8% had heard of vaginal mesh, and most of this information came from a media source followed by their health care provider. A total of 102 of 202 patients completed both the pre- and post-consultation questionnaire. Before medical consultation, patients' "level of concern" on a Likert scale (1 = not at all concerned, 10 = very concerned) was 5.98 ± 3.04. After consultation, the level of concern decreased significantly to 4.25 ± 2.68 (P = 0.00005). Before consultation, 33.3% of patients stated that they would be willing to proceed with surgery using mesh; however, after receiving standardized information on vaginal mesh risks and complications on the basis of the most current information available, 62.8% stated that they would be willing to proceed with mesh if required (P = 0.00001). CONCLUSION Almost 75% of patients presenting for urogynecologic consultation had heard of vaginal mesh use, and 55.7% cited the media as their source of information. Medical consultation significantly reduced the patients' level of concern regarding the use of mesh in PFRS and significantly increased the proportion of patients willing to have mesh placed if appropriate.
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Affiliation(s)
- Adrienne L K Li
- Division of Urogynecology, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON
| | - Patricia E Lee
- Division of Urogynecology, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON.
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Lee W, Tam J, Kobashi K. Surgery for Apical Vaginal Prolapse After Hysterectomy: Abdominal Sacrocolpopexy. Urol Clin North Am 2018; 46:113-121. [PMID: 30466696 DOI: 10.1016/j.ucl.2018.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The number of surgeries for pelvic organ prolapse in the United States is increasing. Abdominal sacrocolpopexy has become the gold standard for women desiring a restorative repair of their apical pelvic organ prolapse. Despite the associated morbidity of abdominal sacrocolpopexy, advances in minimally invasive approaches have safely increased the number of these surgeries performed, especially among urologists. Moreover, a number of studies have demonstrated superior objective outcomes after abdominal sacrocolpopexy when compared with vaginal approaches. Variations in the technique are described, but no consensus exists on a standard approach.
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Affiliation(s)
- Wai Lee
- Virginia Mason Medical Center, 1100 Ninth Avenue, Seattle, WA 98111, USA.
| | - Justina Tam
- Department of Urology, Stony Brook Medicine, 101 Nicolls Road, HSC Level 9-040, Stony Brook, NY 11794, USA
| | - Kathleen Kobashi
- Virginia Mason Medical Center, 1100 Ninth Avenue, Seattle, WA 98111, USA
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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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Gomelsky A. Editorial Comment. Urology 2018; 111:70. [DOI: 10.1016/j.urology.2017.08.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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20
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Plata M, Bravo-Balado A, Robledo D, Castaño JC, Averbeck MA, Plata MA, Cataño JG, Caicedo JI, Trujillo CG. Trends in pelvic organ prolapse management in Latin America. Neurourol Urodyn 2017; 37:1039-1045. [PMID: 28877368 DOI: 10.1002/nau.23392] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/04/2017] [Indexed: 01/19/2023]
Abstract
AIMS To describe practice patterns and perspectives regarding pelvic organ prolapse (POP) management among urologists, gynecologists, and urogynecologists in Latin America (LATAM). METHODS A cross-sectional study was conducted from April to September 2016 using a 37-item internet-based survey applied to members of urologic and gynecologic associations from 18 countries. Participants were asked about their background and practice patterns. Descriptive statistics were employed. RESULTS A total of 673 responses were obtained. Most came from Colombia (33.6%) and Brazil (24.7%). The number of practitioners who perform at least one POP procedure per month and were eligible to finish the survey was 529 (78.6%), out of which 323 (61.0%) were urologists, 156 (29.5%) gynecologists, and 50 (9.5%) urogynecologists. Mesh-based POP repairs were used by 57.1% of participants. Out of non-mesh users, the most frequent vaginal procedures were sacrospinous fixation (30%), colporrhaphy (25%), and uterosacral fixation (12%). Regarding the impact of FDA warnings, 75.2% participants indicated that the use of mesh has declined, and 41.9% considered this has had a negative effect in the use of incontinence tapes as well. Only two physicians reported legal disputes related to mesh procedures, and 75.8% said they would still indicate mesh repairs in certain cases. CONCLUSIONS This is the first report on POP practice patterns in LATAM. Preferences regarding surgical management of POP are not very different from international trends. Despite intense scrutiny and media exposure, mesh-based procedures are still largely used in LATAM.
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Affiliation(s)
- Mauricio Plata
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá D.C., Colombia
| | - Alejandra Bravo-Balado
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá D.C., Colombia
| | - Daniela Robledo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá D.C., Colombia
| | - Juan C Castaño
- Department of Urology, Clínica Universitaria CES, Universidad CES and Pontificia Universidad Bolivariana, Medellín, Colombia
| | - Márcio A Averbeck
- Department of Urology, Mae de Deus Center Hospital, Porto Alegre, Brasil
| | - Manuel A Plata
- Department of Gynecology, Obstetrics and Human Reproduction, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá D.C., Colombia
| | - Juan G Cataño
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá D.C., Colombia
| | - Juan I Caicedo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá D.C., Colombia
| | - Carlos G Trujillo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá D.C., Colombia
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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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22
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Rac G, Greiman A, Rabley A, Tipton TJ, Chiles LR, Freilich DA, Rames R, Cox L, Koski M, Rovner ES. Analysis of Complications of Pelvic Mesh Excision Surgery Using the Clavien-Dindo Classification System. J Urol 2017; 198:638-643. [PMID: 28433641 DOI: 10.1016/j.juro.2017.04.078] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE We describe and categorize complications using the Clavien-Dindo classification system in patients who underwent vaginal mesh excision surgery. MATERIALS AND METHODS With institutional review board approval we retrospectively reviewed the records of 277 patients who underwent vaginal mesh extraction between 2007 and 2015 at a single institution. Surgical complications were stratified using the Clavien-Dindo classification system. Complications were perioperative (prior to discharge) or postoperative (within 90 days). Indications for initial mesh placement, mesh revision procedure, time to resolution and medical comorbidities were assessed. RESULTS Of the 277 patients 47.3% had at least 1 surgical complication, including multiple complications in 7.2%. A total of 155 complications were identified, which were grade II in 49.0% of cases, grade I in 25.8%, grade IIIb in 18.7%, grade IIIa in 5.2% and grade IVa in 1.3%. No grade IVb or V complications were identified. The indication for initial mesh placement did not significantly affect complication frequency. Patients who underwent combined stress urinary incontinence and pelvic organ prolapse mesh revision surgeries had an increased frequency of complications compared to those treated with mesh revision surgery for pelvic organ prolapse or stress urinary incontinence alone (p = 0.045). Most complications occurred postoperatively and resolved by 90 days. Age, body mass index, smoking status and diabetes were not associated with increased complications. CONCLUSIONS Despite the complexity of mesh revision surgery most complications are minor. Serious complications may develop, emphasizing the need for proper patient counseling and surgical experience when performing these procedures.
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Affiliation(s)
- Goran Rac
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina; Urology of Kaiser Permanente Medical Center (MK), San Diego, California
| | - Alyssa Greiman
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina; Urology of Kaiser Permanente Medical Center (MK), San Diego, California
| | - Andrew Rabley
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina; Urology of Kaiser Permanente Medical Center (MK), San Diego, California
| | - T J Tipton
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina; Urology of Kaiser Permanente Medical Center (MK), San Diego, California
| | - Leah R Chiles
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina; Urology of Kaiser Permanente Medical Center (MK), San Diego, California
| | - Drew A Freilich
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina; Urology of Kaiser Permanente Medical Center (MK), San Diego, California
| | - Ross Rames
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina; Urology of Kaiser Permanente Medical Center (MK), San Diego, California
| | - Lindsey Cox
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina; Urology of Kaiser Permanente Medical Center (MK), San Diego, California
| | - Michelle Koski
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina; Urology of Kaiser Permanente Medical Center (MK), San Diego, California
| | - Eric S Rovner
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina; Urology of Kaiser Permanente Medical Center (MK), San Diego, California.
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23
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Drain A, Khan A, Ohmann EL, Brucker BM, Smilen S, Rosenblum N, Nitti VW. Use of Concomitant Stress Incontinence Surgery at Time of Pelvic Organ Prolapse Surgery Since Release of the 2011 Notification on Serious Complications Associated with Transvaginal Mesh. J Urol 2017; 197:1092-1098. [DOI: 10.1016/j.juro.2016.11.087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Alice Drain
- New York University Langone Medical Center, New York, New York
| | - Aqsa Khan
- New York University Langone Medical Center, New York, New York
| | - Erin L. Ohmann
- New York University Langone Medical Center, New York, New York
| | | | - Scott Smilen
- New York University Langone Medical Center, New York, New York
| | - Nirit Rosenblum
- New York University Langone Medical Center, New York, New York
| | - Victor W. Nitti
- New York University Langone Medical Center, New York, New York
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24
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Khan AA, Rosenblum N, Brucker B, Nitti V. Changes in management of stress urinary incontinence following the 2011 FDA Health Notification. JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415817691662] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: We sought to assess for impact on management trends in new patients presenting to our institution with stress urinary incontinence (SUI) following the release of the FDA Health Notification in July 2011 for vaginal mesh. Materials and methods: Chart analysis was performed on patients assigned a primary International Classification of Diseases (ICD-9) diagnosis code of 625.6 for SUI at initial consultation by two providers at our institution between June 1, 2010 and November 30, 2014. Rates of treatment and types of procedures performed were analyzed: urethral bulking, mesh sling, or pubovaginal sling. Results: A total of 333 new patients were identified with an increasing trend over time. One hundred and twenty-three patients underwent 153 procedures for stress incontinence. The mean proportion that had a procedure per six-month period was 37%, with decreasing proportions over time. Initially all procedures were midurethral mesh slings, with a decline at the time of and after the notification, and a temporary increase in bulking procedures. Subsequently, there was a rise again in sling placement, namely with an increase in pubovaginal slings. Of the 20 pubovaginal slings placed, 13 were placed in patients who had a prior anti-incontinence surgery (eight for sling failure, vaginal mesh, or fixed urethra, and two in patients with mesh extrusion/erosion). Seven were performed in patients who had never had prior surgery (two for very high-grade incontinence, two with urethral diverticulectomy, and three in patients who expressed concern about mesh). Conclusions: Although there were an increasing number of patients seen for management of SUI over time, there was a progressive decrease in the proportion of patients having anti-incontinence procedures after release of the FDA notification. There was an overall decrease in the use of mesh slings and an increase in bulking, and more notably, placement of pubovaginal slings.
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Affiliation(s)
- Aqsa A Khan
- Department of Urology, Mayo Clinic Arizona Phoenix, USA
| | - Nirit Rosenblum
- Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Urology, New York University Langone Medical Center, USA
| | - Benjamin Brucker
- Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Urology, New York University Langone Medical Center, USA
| | - Victor Nitti
- Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Urology, New York University Langone Medical Center, USA
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25
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Rac G, Younger A, Clemens JQ, Kobashi K, Khan A, Nitti V, Jacobs I, Lemack GE, Brown ET, Dmochowski R, MacLachlan L, Mourtzinos A, Ginsberg D, Koski M, Rames R, Rovner ES. Stress urinary incontinence surgery trends in academic female pelvic medicine and reconstructive surgery urology practice in the setting of the food and drug administration public health notifications. Neurourol Urodyn 2016; 36:1155-1160. [PMID: 27460448 DOI: 10.1002/nau.23080] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/05/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Goran Rac
- Department of Urology; Medical University of South Carolina; Charleston South Carolina
| | - Austin Younger
- Department of Urology; Medical University of South Carolina; Charleston South Carolina
| | - James Q. Clemens
- Department of Urology; University of Michigan Health Science Center; Ann Arbor Michigan
| | - Kathleen Kobashi
- Section of Urology and Renal Transplantation; Virginia Mason Medical Center; Seattle Washington
| | - Aqsa Khan
- Department of Urology; New York University Langone Medical Center; New York New York
| | - Victor Nitti
- Department of Urology; New York University Langone Medical Center; New York New York
| | - Ilana Jacobs
- Department of Urology; University of Texas Southwestern Medical Center; Dallas Texas
| | - Gary E. Lemack
- Department of Urology; University of Texas Southwestern Medical Center; Dallas Texas
| | - Elizabeth T. Brown
- Department of Urologic Surgery; Vanderbilt University Medical Center; Nashville Tennessee
| | - Roger Dmochowski
- Department of Urologic Surgery; Vanderbilt University Medical Center; Nashville Tennessee
| | - Lara MacLachlan
- Institute of Urology; Lahey Hospital and Medical Center; Burlington Massachusetts
| | - Arthur Mourtzinos
- Institute of Urology; Lahey Hospital and Medical Center; Burlington Massachusetts
| | - David Ginsberg
- Institute of Urology; Keck Medicine of University of Southern California; Los Angeles California
| | - Michelle Koski
- Urology of Kaiser Permanente Medical Center; San Diego California
| | - Ross Rames
- Department of Urology; Medical University of South Carolina; Charleston South Carolina
| | - Eric S. Rovner
- Department of Urology; Medical University of South Carolina; Charleston South Carolina
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26
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Rovner ES, Younger A. Author Reply. Urology 2016; 91:51. [DOI: 10.1016/j.urology.2015.12.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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27
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Younger A, Rac G, Clemens JQ, Kobashi K, Khan A, Nitti V, Jacobs I, Lemack GE, Brown ET, Dmochowski R, Maclachlan L, Mourtzinos A, Ginsberg D, Koski M, Rames R, Rovner E. Pelvic Organ Prolapse Surgery in Academic Female Pelvic Medicine and Reconstructive Surgery Urology Practice in the Setting of the Food and Drug Administration Public Health Notifications. Urology 2016; 91:46-51. [DOI: 10.1016/j.urology.2015.12.057] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 12/28/2015] [Accepted: 12/29/2015] [Indexed: 10/22/2022]
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28
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Brown ET, Cohn JA, Kaufman MR, Reynolds WS, Dmochowski RR. Lessons Learned from Mesh Litigation for Prolapse and Incontinence. CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0353-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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29
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Koo K, Gormley EA. Transvaginal mesh in the media following the 2011 US food and drug administration public health notification update. Neurourol Urodyn 2015; 36:329-332. [DOI: 10.1002/nau.22923] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 10/14/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Kevin Koo
- Section of Urology, Department of Surgery; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
| | - E. Ann Gormley
- Section of Urology, Department of Surgery; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
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30
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Tippett EC, Chen BK. Association of Attorney Advertising and FDA Action with Prescription Claims: A Time Series Segmented Regression Analysis. Drug Saf 2015; 38:1169-78. [PMID: 26384489 DOI: 10.1007/s40264-015-0340-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Attorneys sponsor television advertisements that include repeated warnings about adverse drug events to solicit consumers for lawsuits against drug manufacturers. The relationship between such advertising, safety actions by the US Food and Drug Administration (FDA), and healthcare use is unknown. OBJECTIVES To investigate the relationship between attorney advertising, FDA actions, and prescription drug claims. METHODS The study examined total users per month and prescription rates for seven drugs with substantial attorney advertising volume and FDA or other safety interventions during 2009. Segmented regression analysis was used to detect pre-intervention trends, post-intervention level changes, and changes in post-intervention trends relative to the pre-intervention trends in the use of these seven drugs, using advertising volume, media hits, and the number of Medicare enrollees as covariates. Data for these variables were obtained from the Center for Medicare and Medicaid Services, Kantar Media, and LexisNexis. RESULTS Several types of safety actions were associated with reductions in drug users and/or prescription rates, particularly for fentanyl, varenicline, and paroxetine. In most cases, attorney advertising volume rose in conjunction with major safety actions. Attorney advertising volume was positively correlated with prescription rates in five of seven drugs, likely because advertising volume began rising before safety actions, when prescription rates were still increasing. On the other hand, attorney advertising had mixed associations with the number of users per month. CONCLUSION Regulatory and safety actions likely reduced the number of users and/or prescription rates for some drugs. Attorneys may have strategically chosen to begin advertising adverse drug events prior to major safety actions, but we found little evidence that attorney advertising reduced drug use. Further research is needed to better understand how consumers and physicians respond to attorney advertising.
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Affiliation(s)
- Elizabeth C Tippett
- School of Law, University of Oregon, 1221 University of Oregon, Eugene, OR, 97405, USA.
| | - Brian K Chen
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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31
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Winters JC. Pursuing Perfection in Prolapse and Anti-Incontinence Surgery--A Square Peg in a Round Hole? J Urol 2015; 194:621-2. [PMID: 26079329 DOI: 10.1016/j.juro.2015.06.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Indexed: 10/23/2022]
Affiliation(s)
- J Christian Winters
- Department of Urology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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32
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Chughtai B, Mao J, Buck J, Kaplan S, Sedrakyan A. Use and risks of surgical mesh for pelvic organ prolapse surgery in women in New York state: population based cohort study. BMJ 2015; 350:h2685. [PMID: 26037077 PMCID: PMC4451585 DOI: 10.1136/bmj.h2685] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the use of mesh in pelvic organ prolapse surgery, and compare short term outcomes between procedures using and not using mesh. DESIGN All inclusive, population based cohort study. SETTING Statewide surgical care captured in the New York Statewide Planning and Research Cooperative System. PARTICIPANTS Women who underwent prolapse repair procedures in New York state from 2008 to 2011. MAIN OUTCOMES MEASURES 90 day safety events and reinterventions within one year, after propensity score matching. Categorical, time to event, and subgroup analyses (<65 and ≥ 65 year age groups) were conducted. RESULTS Of 27,991 patients in total, 7338 and 20, 653 underwent prolapse repair procedures with and without mesh, respectively. Mesh use increased by 44.7%, from 1461 procedures in 2008 to 2114 procedures in 2011. Most patients in the cohort were younger than 65 years (62.3% (n=17,424/27, 991)). However, more patients were aged 65 years and older in the mesh group than in the non-mesh group (44.3% (n=3249) v 35.4% (n=7318)). Complications after surgery were not common, irrespective of the use or non-use of mesh. After propensity score matching, patients who received the surgery with mesh had a higher chance of having a reintervention within one year (mesh 3.3% v no mesh 2.2%, hazard ratio 1.47 (95% confidence interval 1.21 to 1.79)) and were more likely to have urinary retention within 90 days (mesh 7.5% v no mesh 5.6%, risk ratio 1.33 (95% confidence interval 1.18 to 1.51)), compared with those who received surgery without mesh. In subgroup analyses based on age, mesh use was associated with an increased risk of reintervention within one year in patients under age 65 years, and increased risk of urinary retention in patients aged 65 years and over. CONCLUSIONS Despite multiple warnings released by the US Food and Drug Administration since 2008, use of mesh in pelvic organ prolapse surgery continues to grow. In this statewide comprehensive study, mesh procedures were associated with an increased risk of reinterventions within one year and urinary retention after surgery.
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Affiliation(s)
- Bilal Chughtai
- Department of Urology, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, NY, USA
| | - Jialin Mao
- Patient-Centered Comparative Effectiveness Program and MDEpiNet Science and Infrastructure Centre, Department of Healthcare Policy and Research at Weill Cornell Medical College and New York Presbyterian, New York, NY 10065, USA
| | - Jessica Buck
- Department of Urology, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, NY, USA
| | - Steven Kaplan
- Department of Urology, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, NY, USA
| | - Art Sedrakyan
- Patient-Centered Comparative Effectiveness Program and MDEpiNet Science and Infrastructure Centre, Department of Healthcare Policy and Research at Weill Cornell Medical College and New York Presbyterian, New York, NY 10065, USA
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Rovner ES. Progress in Stress Incontinence Surgery—Are We Destined to Fail? J Urol 2015; 193:758-9. [DOI: 10.1016/j.juro.2014.12.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Eric S. Rovner
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina
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Perkins CE, Warrior K, Eilber KS, McClelland L, Anger JT. The Role of Mid-urethral Slings in 2014: Analysis of the Impact of Litigation on Practice. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-014-0278-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Badlani GH. Editorial comment. Urology 2015; 85:331-2. [PMID: 25623678 DOI: 10.1016/j.urology.2014.08.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Gopal H Badlani
- Department of Urology, Wake Forest University Health Sciences Center, Winston-Salem, NC
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Tippett E. Medical Advice from Lawyers: A Content Analysis of Advertising for Drug Injury Lawsuits. AMERICAN JOURNAL OF LAW & MEDICINE 2015; 41:7-48. [PMID: 26237982 DOI: 10.1177/0098858815591508] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study examined the medical information contained in a sample of television ads soliciting consumers for lawsuits against drug and medical device manufactures. Almost all such ads involved drugs or devices that have not been recalled and remain on the market. These ads raise important public health questions because they may influence the prospective medical decisions of viewers. The ads contained extensive descriptions of serious adverse events associated with the drugs or devices but almost uniformly failed to disclose information relating to the likelihood of such events. They also failed to effectively advise viewers to consult a doctor. Results also identified a subset of ads that mimicked public service announcements, claiming to be. a "medical alert" "consumer alert" or "FDA warning" at the start of the ad. Most such ads did not disclose the attorney source of the advertising until the final few seconds.
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