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LAS VEGAS – A few weeks before she was scheduled to speak at the annual Pelvic Anatomy and Gynecologic Surgery Symposium, Beri M. Ridgeway, MD, received an anonymous note about her upcoming presentation. “Someone wanted me to think very carefully about what I’d be talking about during my presentation on synthetics,” she recalled.
The note reflects the deep controversy over the use of transvaginal synthetic mesh products, which have been linked to a long list of serious adverse effects. “There are women who have been harmed, and I take care of a lot of those,” said Dr. Ridgeway, who’s based at Cleveland Clinic. One key distinction is that there is a very different risk profile between transvaginal synthetic mesh prolapse kits and polypropylene midurethral slings. While it’s important to be thoughtful about the use of mesh in synthetic midurethral (MU) slings, she said, they remain well supported as an effective treatment for stress urinary incontinence (SUI).
Even so, she said, the news about the risks of mesh “weighs on our patients’ minds” and spawns fear among physicians. Meanwhile, she said, “there is quite a bit of flux” in the marketplace as companies withdraw products because of their perception of risk.
Even amid the controversy, she said, it’s important to remember how crucial it is to treat women in need. “SUI is a very common problem, and women suffer significantly. With our aging population, the prevalence will increase even more,” she said. “It is critical that we screen patients for SUI and have the ability to offer treatment. Having different treatment options benefit women significantly.”
Dr. Ridgeway offered these pearls about the use of synthetic MU slings and alternative approaches to treating SUI.
It’s helpful to find a single strategy and embrace it.
“For ob.gyn. specialists who treat primary, uncomplicated SUI, I recommend surgeons become comfortable with an approach and focus on becoming high-volume surgeons in that approach,” Dr. Ridgeway said. “It is also good to partner with a female pelvic medicine & reconstructive surgery specialist who can back one up for more complicated cases, complications, or recurrent SUI. These specialists should be able to offer a full array of procedures to treat SUI and tailor the treatment to the individual patient, especially in more complex cases.”
Synthetic MU slings are the “definitive standard of care.”
More than 17 years of research suggest the efficacy of the slings is durable, she said, especially when the goal is to resolve symptoms in patients with pure SUI symptoms. she said, pointing to more than 500 articles and more than 40 randomized controlled trials.
According to her, synthetic slings have similar efficacy to traditional slings but require less time in the operating room and produce less voiding dysfunction and de novo urgency. “The revision rate of synthetic MU slings is very low,” she added. “In large studies, the revision rate at 10 years is 3%-4%.”
It’s important to keep patient consent in mind, she said. “Patients should know and understand the specific risks of any procedure, including MU slings, so that they can share in decision making.”
Transobdurator (TOT) slings offer benefits.
There’s less risk of bladder and vascular injury from the TOT procedure, which is easy to learn and teach, Dr. Ridgeway said. Research suggests the tension-free vaginal tape (TVT) approach is more likely to cause voiding dysfunction, she added.
But TOT is probably less effective in patients with SUI linked to intrinsic sphincter deficiency and in longer-term follow-up, she said. And there are cases of male sex partners injuring their penises during contact with TOT slings during intercourse.
Single-incision slings are up-and-coming options.
These slings offer promising results in short-term studies, but long-term results aren’t available yet. They may be a good option for cases of mild and occult SUI, she said.
Alternative treatments for SUI have limitations.
These include urethral bulking agents, which mainly lead to improvement rather than cure. Autologous fascial pubovaginal slings are another option, especially if patients don’t want a mesh-based treatment or have recurrent SUI following a synthetic mesh complication. However, she noted that research points to morbidity and de novo urinary urgency, she said.
The Pelvic Anatomy & Gynecologic Surgery Symposium was jointly provided by Global Academy for Medical Education and the University of Cincinnati. Global Academy and this news organization are owned by the same company.
Dr. Ridgeway disclosed consulting for Coloplast and having served as an independent contractor (legal) for Ethicon.
LAS VEGAS – A few weeks before she was scheduled to speak at the annual Pelvic Anatomy and Gynecologic Surgery Symposium, Beri M. Ridgeway, MD, received an anonymous note about her upcoming presentation. “Someone wanted me to think very carefully about what I’d be talking about during my presentation on synthetics,” she recalled.
The note reflects the deep controversy over the use of transvaginal synthetic mesh products, which have been linked to a long list of serious adverse effects. “There are women who have been harmed, and I take care of a lot of those,” said Dr. Ridgeway, who’s based at Cleveland Clinic. One key distinction is that there is a very different risk profile between transvaginal synthetic mesh prolapse kits and polypropylene midurethral slings. While it’s important to be thoughtful about the use of mesh in synthetic midurethral (MU) slings, she said, they remain well supported as an effective treatment for stress urinary incontinence (SUI).
Even so, she said, the news about the risks of mesh “weighs on our patients’ minds” and spawns fear among physicians. Meanwhile, she said, “there is quite a bit of flux” in the marketplace as companies withdraw products because of their perception of risk.
Even amid the controversy, she said, it’s important to remember how crucial it is to treat women in need. “SUI is a very common problem, and women suffer significantly. With our aging population, the prevalence will increase even more,” she said. “It is critical that we screen patients for SUI and have the ability to offer treatment. Having different treatment options benefit women significantly.”
Dr. Ridgeway offered these pearls about the use of synthetic MU slings and alternative approaches to treating SUI.
It’s helpful to find a single strategy and embrace it.
“For ob.gyn. specialists who treat primary, uncomplicated SUI, I recommend surgeons become comfortable with an approach and focus on becoming high-volume surgeons in that approach,” Dr. Ridgeway said. “It is also good to partner with a female pelvic medicine & reconstructive surgery specialist who can back one up for more complicated cases, complications, or recurrent SUI. These specialists should be able to offer a full array of procedures to treat SUI and tailor the treatment to the individual patient, especially in more complex cases.”
Synthetic MU slings are the “definitive standard of care.”
More than 17 years of research suggest the efficacy of the slings is durable, she said, especially when the goal is to resolve symptoms in patients with pure SUI symptoms. she said, pointing to more than 500 articles and more than 40 randomized controlled trials.
According to her, synthetic slings have similar efficacy to traditional slings but require less time in the operating room and produce less voiding dysfunction and de novo urgency. “The revision rate of synthetic MU slings is very low,” she added. “In large studies, the revision rate at 10 years is 3%-4%.”
It’s important to keep patient consent in mind, she said. “Patients should know and understand the specific risks of any procedure, including MU slings, so that they can share in decision making.”
Transobdurator (TOT) slings offer benefits.
There’s less risk of bladder and vascular injury from the TOT procedure, which is easy to learn and teach, Dr. Ridgeway said. Research suggests the tension-free vaginal tape (TVT) approach is more likely to cause voiding dysfunction, she added.
But TOT is probably less effective in patients with SUI linked to intrinsic sphincter deficiency and in longer-term follow-up, she said. And there are cases of male sex partners injuring their penises during contact with TOT slings during intercourse.
Single-incision slings are up-and-coming options.
These slings offer promising results in short-term studies, but long-term results aren’t available yet. They may be a good option for cases of mild and occult SUI, she said.
Alternative treatments for SUI have limitations.
These include urethral bulking agents, which mainly lead to improvement rather than cure. Autologous fascial pubovaginal slings are another option, especially if patients don’t want a mesh-based treatment or have recurrent SUI following a synthetic mesh complication. However, she noted that research points to morbidity and de novo urinary urgency, she said.
The Pelvic Anatomy & Gynecologic Surgery Symposium was jointly provided by Global Academy for Medical Education and the University of Cincinnati. Global Academy and this news organization are owned by the same company.
Dr. Ridgeway disclosed consulting for Coloplast and having served as an independent contractor (legal) for Ethicon.
LAS VEGAS – A few weeks before she was scheduled to speak at the annual Pelvic Anatomy and Gynecologic Surgery Symposium, Beri M. Ridgeway, MD, received an anonymous note about her upcoming presentation. “Someone wanted me to think very carefully about what I’d be talking about during my presentation on synthetics,” she recalled.
The note reflects the deep controversy over the use of transvaginal synthetic mesh products, which have been linked to a long list of serious adverse effects. “There are women who have been harmed, and I take care of a lot of those,” said Dr. Ridgeway, who’s based at Cleveland Clinic. One key distinction is that there is a very different risk profile between transvaginal synthetic mesh prolapse kits and polypropylene midurethral slings. While it’s important to be thoughtful about the use of mesh in synthetic midurethral (MU) slings, she said, they remain well supported as an effective treatment for stress urinary incontinence (SUI).
Even so, she said, the news about the risks of mesh “weighs on our patients’ minds” and spawns fear among physicians. Meanwhile, she said, “there is quite a bit of flux” in the marketplace as companies withdraw products because of their perception of risk.
Even amid the controversy, she said, it’s important to remember how crucial it is to treat women in need. “SUI is a very common problem, and women suffer significantly. With our aging population, the prevalence will increase even more,” she said. “It is critical that we screen patients for SUI and have the ability to offer treatment. Having different treatment options benefit women significantly.”
Dr. Ridgeway offered these pearls about the use of synthetic MU slings and alternative approaches to treating SUI.
It’s helpful to find a single strategy and embrace it.
“For ob.gyn. specialists who treat primary, uncomplicated SUI, I recommend surgeons become comfortable with an approach and focus on becoming high-volume surgeons in that approach,” Dr. Ridgeway said. “It is also good to partner with a female pelvic medicine & reconstructive surgery specialist who can back one up for more complicated cases, complications, or recurrent SUI. These specialists should be able to offer a full array of procedures to treat SUI and tailor the treatment to the individual patient, especially in more complex cases.”
Synthetic MU slings are the “definitive standard of care.”
More than 17 years of research suggest the efficacy of the slings is durable, she said, especially when the goal is to resolve symptoms in patients with pure SUI symptoms. she said, pointing to more than 500 articles and more than 40 randomized controlled trials.
According to her, synthetic slings have similar efficacy to traditional slings but require less time in the operating room and produce less voiding dysfunction and de novo urgency. “The revision rate of synthetic MU slings is very low,” she added. “In large studies, the revision rate at 10 years is 3%-4%.”
It’s important to keep patient consent in mind, she said. “Patients should know and understand the specific risks of any procedure, including MU slings, so that they can share in decision making.”
Transobdurator (TOT) slings offer benefits.
There’s less risk of bladder and vascular injury from the TOT procedure, which is easy to learn and teach, Dr. Ridgeway said. Research suggests the tension-free vaginal tape (TVT) approach is more likely to cause voiding dysfunction, she added.
But TOT is probably less effective in patients with SUI linked to intrinsic sphincter deficiency and in longer-term follow-up, she said. And there are cases of male sex partners injuring their penises during contact with TOT slings during intercourse.
Single-incision slings are up-and-coming options.
These slings offer promising results in short-term studies, but long-term results aren’t available yet. They may be a good option for cases of mild and occult SUI, she said.
Alternative treatments for SUI have limitations.
These include urethral bulking agents, which mainly lead to improvement rather than cure. Autologous fascial pubovaginal slings are another option, especially if patients don’t want a mesh-based treatment or have recurrent SUI following a synthetic mesh complication. However, she noted that research points to morbidity and de novo urinary urgency, she said.
The Pelvic Anatomy & Gynecologic Surgery Symposium was jointly provided by Global Academy for Medical Education and the University of Cincinnati. Global Academy and this news organization are owned by the same company.
Dr. Ridgeway disclosed consulting for Coloplast and having served as an independent contractor (legal) for Ethicon.
EXPERT ANALYSIS FROM PAGS