Transvaginal Mesh Complications Lower In High Volume Surgical Practices Interview with:
Blayne Welk MD Assistant Professor in the Division of Urology The University of Western OntarioBlayne Welk MD
Assistant Professor in the Division of Urology
The University of Western Ontario

Medical Research: What is the background for this study? What are the main findings?

Dr. Welk: Stress incontinence is a common problem among women. The most frequently used surgical treatment is a mesh-based midurethral sling. This procedure is commonly called a transvaginal sling, and is usually an outpatient procedure that takes about an hour in the operating room. However, there has been significant concern about some of the complications of this procedure, which include chronic pain, and mesh erosions into the urinary tract. This prompted the FDA and Health Canada to issue warnings regarding the use of transvaginal mesh, and numerous lawsuits have been launched against manufactures of transvaginal mesh products.

This study by Dr Welk and colleagues identifies the long term rate of surgical treated complications among a group of almost 60,000 women who had mesh based incontinence procedures between 2002-2012. The rate of surgically treated complications at 1 year is 1.2%, however this increased to 3.3% after 10 years of followup. The FDA and Health Canada recommend that surgeons obtain training and experience in their chosen type of midurethral sling, and we demonstrated that patients of high volume surgeons (who frequently performed mesh based incontinence procedures) were 27% less likely to have one of these complications.

Medical Research: What should clinicians and patients take away from your report?

Dr. Welk: Up to 1/30 women may have complications from their midurethral mesh sling that will require a surgical procedure to remove or revise the mesh.  Our results substantiate some of the regulatory recommendations around the use of transvaginal mesh: namely that complications are not infrequent, and that surgeons should obtain experience in the procedure. Patients should make sure they discuss the risks and benefits of this procedure with their surgeon, and ensure that their surgeon is comfortable managing the potential complications of this procedure.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Welk: Further research should attempt to identify women at risk for specific complications. We were unable to identify specific sling types with our study, and future observational studies should try and characterize this variable in order to assess the safety of specific products and techniques.

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Blayne Welk MD (2015). Transvaginal Mesh Complications Lower In High Volume Surgical Practices 

Last Updated on September 10, 2015 by Marie Benz MD FAAD