I've been following the development of the vaginal mesh class action lawsuits with interest. Please read my essay dated August 2008 on this website, under the title 'New Devices'. You'll see that I predicted a major class action lawsuit coming soon, at that time! Here were my exact words quoted from my 2008 whitepaper:
Naturally, many women who have either received mesh, or are about to, are concerned. Unfortunately, the media and specifically the lawyers who make their living by drumming up the public angst about this issue as much as they can, have distorted the problem out of all reality. They make it sound as if anyone who had ever received mesh was the victim of some conspiracy to harm women. They also lump every mesh, be that prolapse mesh, incontinence slings or placement by whatever method or route, together. I spoke to one of the lead lawyers on the Canadian suit this week and he admitted that they don't really understand the issues very well. How can they after all - it's very complicated. That is why I don't begrudge them their efforts one bit. They are doing their job, which is doing business, making money, and in the process helping some people. Unfortunately the distortion of the facts could potentially in fact harm some patients by making them unnecessarily fearful of treatment options that would have been good choices for them. I'm specifically thinking here of the incontinence sling procedures. I'm not for one moment denying that there are risks. These are however not the same for all procedures and besides, ALL surgery has risks. If you don't want to risk any complication, then don't have surgery - it's as simple as that. You will not find 'riskless' surgery and anyone promising that, will likely next try to sell you prime Florida wilderness real estate.
By throwing out the baby with the bathwater, we risk going back twenty years to a time where incontinence surgery involved a major abdominal operation, not nearly as effective as today's minimally invasive procedures, with long recovery times, high intra-operative risks, long operative times, much much longer wait times for surgery, much higher cost, and worse outcomes. Maybe the lawyers don't care - they are looking at the immediate upside of having a patient phone them and signing on. You should care about what is the truth however, since the best surgery might not be there for you, if we let emotion get the better of science and fact.
As for prolapse procedures and vaginal mesh for prolapse, I stand by what I wrote in my 2008 essay. I will just say this: We are more and more learning about which patients have a reasonable prognosis for surgical cure and who not. Some simply cannot be cured, and even improvement of prolapse might be a tall order. For some women, the only realistic or conceivable long-term possibility of a surgical success, will involve a mesh of some sort, placed in some or other way. I agree that for most women synthetic mesh is not needed and reasonable to even good outcomes can be obtained by techniques using native tissue or Xenografts (animal grafts), but that is not true for all. Colposacropexy for instance always involves synthetic mesh, and although specifically excluded by the FDA from their 'warning' and labeled the 'gold standard', it involves the same mesh as is now so demonized by the class action lawyers.
This current hysteria might have the eventual effect of denying specialist surgeons the ability to be able to offer these unfortunate women anything at all. I've heard prolapse been called 'quality of life' problems. Indeed, for many women that is what they are, but for some, these are devastating conditions that can destroy their lives and leave them as pelvic cripples. You do not ever want to hear that from your urogynecologist.
So, next time you watch a youtube video or a news story about one unfortunate woman who developed a complication of some procedure, remember that there are hundreds of thousands of yet untreated women out there who are in similar or worse shape who require us as specialist gynecologists and urologists to come up with a plan to care for them and solutions to treat their problems. For some of these at least, mesh will have to play a role.
The legal system has its role. If you read my 2008 Essay you will know that I am not an apologist for the device industry and I am not stating all is roses. However just beware having media hysteria and easy to publish junk science control the agenda and handcuff honest, ethical, caring and highly trained specialists who have dedicated their lives to pelvic floor problems, from helping you.
One last observation. In my 2008 letter I rile against some surgeons who always have to be the first to jump on every new device bandwagon and be the first out of the block using it, thereby giving themselves claims of special expertise and getting recognized as 'The Best'. Well, it is interesting that some of these same individuals are now transforming themselves, chameleon-like, into THE go-to experts in removing every possible mesh. Self promotion is reasonable to a point, but integrity is even more important. For some, the exposure is all important and the reality is secondary. Caveat emptor!
The pelvic floor is one of the body's most interesting organ structures, but unfortunately, also one of the least understood and most neglected.
This is perhaps not surprising, in light of the fact that even some physicians have problems understanding, and visualizing the pelvic floor. Outside of health-care circles, the pelvic floor is virtually unknown. In contrast to its low profile, the pelvic floor plays a vitally important role in many of the human body's most important intimate and reproductive functions. In women it becomes even more crucial to the health and happiness of the individual, and is intimately involved in labor and delivery. With its central role in sexuality and childbirth, the female pelvic floor is most intimately concerned with femininity. In both men and women, the pelvic floor is also involved with excretory functions namely urination and defecation.
Unfortunately, the female pelvic floor is vulnerable to the development of numerous disorders, which could seriously affect the quality of life of the individual. The main reasons for this are the specifics of female anatomy, aging and vaginal childbirth.
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