New Anti-Incontinence Surgery Uses No Synthetic Mesh

Daniel S. Elliott, M.D MAYO Clinic, Associate Professor Department of Urology Section of Pelvic and Reconstructive Surgery Rochester, Interview with:
Daniel S. Elliott, M.D
MAYO Clinic, Associate Professor
Department of Urology
Section of Pelvic and Reconstructive Surgery
Rochester, Minnesota

MedicalResearch: What are the main findings of the study? 

Dr. Elliott: The biggest issue is that we were able to devise a new procedure that is a simple outpatient anti-incontinence surgery for women that does NOT use any synthetic meshes.  The importance of this is that all traditional (meaning NON-mesh) surgeries for female incontinence have been large surgeries with fairly significant risks such as pain, bleeding and prolonged recovery.  When the meshes came out in the late ‘90’s, their big benefit was that they were outpatient and quick procedures.  But now that we are discovering all the long term complications from meshes such as chronic pain, scarring, painful intercourse, vaginal extrusion of the meshes, and organ injury, patients have become VERY reluctant and fearful to undergo any mesh type surgery.    Therefore, we devised a new procedure that used a very small piece of the patient’s own tissue (from the rectus fascia) and placed this via the “transobturator route.”  In the process, we melded together the “best” of both worlds—a NON-mesh, outpatient anti-incontinence procedure that is safe (no long term problems as seen with meshes) .

MedicalResearch: Were any of the findings unexpected? 

Dr. Elliott: Probably the biggest surprise is how much fear there is out there regarding meshes and their complications.  When we discussed our procedure with patients they were very eager to avoid anything to do with meshes.  Regarding our results, we  were very pleased the procedure was almost always able to be performed as an outpatient and the pain level was quite tolerable for the patient.

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

Dr. Elliott: That patients suffering from stress urinary incontinence have an option that avoids the long term complications of meshes.  Until, just recently, if a patient wanted to avoid meshes and didn’t want a large surgery then she had no effective choice.  Now, she has a choice that has been shown to work well in our series.

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

Dr. Elliott: We definitely need longer follow up on our patients to determine the procedure’s long term efficacy.  We are thoroughly following and evaluating all our patients so as time passes we will have this data.


Autologous Transobturator Mid-Urethral Sling for Female Stress Urinary Incontinence 

Abstract Presented at the 2014 American Urological Association