Use of Mesh Surgery For Prolapse Continues To Rise

MedicalResearch.com Interview with:
Bilal Chughtai, MD & Art Sedrakyan, MD, PhD
Department of Urology
Weill Cornell Medical College

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

Response: Since 2008, the U.S. Food and Drug Administration has released number of public health notifications cautioning the use of mesh in pelvic organ prolapse (POP) surgery. Despite these notifications and subsequent public scrutiny, studies have reported a large increase of mesh use in female patients with pelvic organ prolapse during the last decade. In light of the reported rise in mesh utilization, we sought to determine the use of mesh in prolapse surgery and compare short-term outcomes of prolapse surgery with or without mesh.

After identifying 7,338 and 20,653 patients who underwent prolapse repair procedures with and without mesh in a 4-year period, we found that mesh use increased 44.7%. Most patients were under 65 (62.3%), and there were more patients older than 65 years in the mesh group (44.3% versus 35.4%). Overall, complications were not common. However, patients who received mesh were more likely to experience urinary retention within 90-days and had a higher chance of having re-intervention at 1 year. Mesh use was also associated with higher risk of urinary retention in older patients (≥ 65 year olds) and re-intervention within 1 year in younger patients (<65 year olds).

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

Response: Younger patients (<65) should be aware that they are at higher risk for mesh exposure and re-intervention. Elderly patients (≥65) should be aware that they are at higher risk for developing urinary retention after POP surgical repair with mesh. Clinicians should counsel patients about these risks.

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

Response: The use of mesh continues to rise, and therefore, more research needs to be conducted to ensure its safety. The FDA has ordered manufacturers to conduct post market surveillance studies; however, it will take years before this data will be available. Future research evaluating the use and safety of mesh for pelvic organ prolapse surgical repair would greatly benefit from a comprehensive registry.

Citation:

Chughtai Bilal, Mao Jialin, Buck Jessica, Kaplan Steven, Sedrakyan Art. 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

 

MedicalResearch.com Interview with:, Bilal Chughtai, MD & Art Sedrakyan, MD, PhD, Department of Urology, & Weill Cornell Medical College (2015). Use of Mesh Surgery For Prolapse Continues To Rise 

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