Mesh Use Declines for Transvaginal POP Repair

Specialists have decreased their use of mesh for recurrent vaginal pelvic organ prolapse (POP) repair, according to a recent survey.

This followed the July 2011 warning by the FDA that vaginal mesh products are associated with significant morbidity without conclusively improving outcomes compared with traditional native tissue repair.

At the 33rd Annual Scientific Meeting of the American Urogynecologic Society, a team led by Catherine Matthews, MD, of the University of North Carolina at Chapel Hill, presented results from a November 2011 survey of surgeons. The results also showed that specialists have increased their use of mesh for primary abdominal POP repair.

The investigators conducted the survey to determine whether the FDA's warning was having any effect on surgeon practice patterns. The update documented a fivefold increase in mesh-associated complications since 2008, totaling 2,874 cases. In that interval, the FDA received reports of neuromuscular problems, vaginal scarring or shrinking, and three deaths directly related to mesh replacement. The update stated that the FDA encourages health care providers to recognize “that in most cases, POP can be treated successfully without mesh, thus avoiding the risk of mesh-related complications.” It also noted that mesh placed abdominally for POP repair “may result in lower rates of mesh complications compared to transvaginal POP surgery with mesh.”

A total of 281 physicians completed the survey at the 2011 annual meeting of the American Association of Gynecologic Laparoscopists (AAGL). Of these, 202 (72%) reported performing surgery for POP and/or stress urinary incontinence (SUI). Eight-four percent of respondents were attending physicians and about 67% had at least 10 years' experience. Only three (1%) of the 281 respondents were urologists; 136 (48.4%) were generalist obstetricians-gynecologists.

The survey results showed that specialists were significantly more likely to use mesh for abdominal POP repair than generalists, as they were for vaginal POP repair (86% vs. 56.3% and 65.9% vs. 37.2%, respectively). Furthermore, specialists were more likely than generalists to use mesh for anterior-compartment, posterior-compartment, anterior/apical-compartment, and posterior/apical-compartment repairs, as well as to use total vaginal mesh kits.

Survey respondents had increased their use of mesh for primary abdominal POP repair and decreased mesh use for recurrent vaginal POP repair (from 82 respondents to 92 and from 99 to 75, respectively). Surgeons were more likely not to use mesh for recurrent prolapse.

Overall, 23% reported that they intended to decrease their use of mesh. One fifth of respondents reported using vaginal mesh only for recurrent prolapse, 5.9% reported not using any vaginal mesh, and 7.7% said they referred patients to a different provider for assessment of whether to use mesh.

Just over half (53.7%) reported changing their counseling methods to include more mesh-specific information.

Primary investigator Erinn M. Myers, MD, a Female Pelvic Medicine and Reconstructive Surgery fellow, cautioned that the survey was conducted with a small self-selected sample of physicians (those attending the 2011 AAGL meeting), and thus may not be an accurate assessment of all physicians. “We have considered doing another survey, but have not made any definitive plans at this time,” Dr. Myers said.

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