This is a question I get regularly. Sometimes it is framed as a rhetorical question, but othertimes it is real; surprising as that may seem. People often need help with difficult decisions. The problem is of course that no one can really make such a decision, other than yourself. Only you know the impact of the problem on your quality of life, your relationships, and what your risk tolerance and tolerance for pain, recovery, and downtime is. Only you know what your financial position is; will it for instance be better to pay out of pocket for a treatment that has no downtime so that you can immediately return to work for instance, or will the recovery time away from work not affect your finances, future standing in your work or whatever project you might be busy with. Are you aware of, and do you accept that even if you choose surgery, that it might not be a complete solution nor the last surgery you might need for this problem?
Nobody can make these decisions except yourself, maybe with the help of your family.
I'm about to tell you a very important secret. It will shock you and disturb you. It will make you angry, and possibly miserable. But it will also make you free. Free from unreasonable expectations. Free from unneccessary but inevitable disappointment. Free from chasing after unattainable perfection and free from blaming others, including your surgeon.
You see - for too long physicians, gynecologists and pelvic floor surgeons have misled their patients into thinking they can do, and accomplish, that which they cannot.
A recently published scientific article confirmed the effectiveness of Erbium Yag laser treatment for urinary incontinence. This is just ONE example of over forty peer reviewed articles now proving the effectiveness of Erbium Yag laser for a variety of urogynecological indications, with indications increasing and expanding, as experience shows successful outcomes with treatment.
Here is a link to the abstract on Pubmed, which is the biggest medical scientific database in the world.
Laser vs TVT and TOT mesh sling
The FDA recently published a warning about the proliferation of unproven and dangerous laser and other energy devices for vaginal treatments. I completely agree with the warning. We are back to a situation when mesh first became popular, with rapid industry mobilization into a market where they perceive easy profit to be made. In 2008 I wrote an article about the situation with mesh, and predicted a class action lawsuit and problems. That article can be read, unaltered from my 2008 writing, below, under the heading: 'New Devices'. Now it is about energy devices. The important thing is that the problem is with unproven, unregulated machines and uneducated users and providers. Not all lasers are the same and not all mesh is the same. It can be used safely, with effectiveness, but it can also be abused by unscrupulous companies and naive providers.
Technological advances in medicine has gained momentum in all fields, with regenerative medicine and anti-aging medicine in the lead. Tremendous advances have been made already and some of the predictions for the future are almost mindboggling. Increased expected lifespans don't even seem to be a debating point anymore - it is generally accepted that it is coming.
I am one of the first practitioners in Canada to introduce and offer direct, intra-urethral but office based laser treatment for certain types of difficult to treat stress urinary incontinence and overactive bladder (OAB). Currently certain types of these conditions are very difficult to treat, and in some cases almost untreatable because of associated medical problems that rule out surgery. Our current treatment options for some such situations are highly unsatisfactory, and often don’t work very well.
The International Urogynecological Association's 41st annual meeting was held in Cape Town, South Africa in early August, 2016. Dr. Murphy was honoured by being asked to be on faculty for the conference, and was one of a select few people who taught during the two full day courses held for international delegates. He gave four lectures in total, during the workshop and course titled: Current controversies in pelvic floor surgery. The invitation re-confirms Dr. Murphy's standing in the international community as an recognized international expert.
The 2017 International Urogynecological Association meeting was held in Vancouver in June. During the meeting two internationally recognized expert surgeons were asked to do demonstration surgery, and Dr. Murphy was one of them. The other was Dr. John Gebhart from the Mayo Clinic in the US. The surgery was performed on stage, on cadaver patients, in front of a live audience. The procedures were broadcast in real time on large screens and were interactive, with both surgeons wearing microphones. On stage was an internationally recognized expert panel for moderation and keeping the surgeons' feet to the fire.
Letter written by Dr. Murphy in 2008 predicting mesh related class action lawsuits:
Pelvic Health & Childbirth was published already in 2003. During the years since then there have been significant developments in the recognition and treatment of pelvic floor disorders, especially incontinence and pelvic organ prolapse.
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: