FDA Warnings on Urogynecologic Mesh: An Overview

This article will detail the original warnings the FDA issued regarding urogynecologic mesh when used in pelvic organ prolapse surgical applications. According to an article titled An Appraisal of the Food and Drug Administration Warning on Urogynecologic Surgical Mesh published in Current Urology Reports (2012 13:231-239), permanent surgical mesh has been used in various applications for several decades, having been used in the repair of hernias since the 1950’s.

The FDA’s July 2011 report on Urogynecologic Surgical Mesh defines surgical mesh as “a metallic or polymeric screen intended to be implanted to reinforce soft tissue or bone where weakness exists.” Beginning in the 1970’s surgical mesh made its appearance in abdominal surgeries for pelvic organ prolapse, then in the 1980’s surgeons began using synthetic slings in the treatment of stress urinary incontinence. It was not until 1996, however, that the FDA approved a type of mesh particularly for use in stress urinary incontinence surgical procedures. Some six years later, in 2002, the Federal Drug Administration approved surgical mesh as an application for the treatment of pelvic organ prolapse. 

How Effective have the FDA’s Warnings on Urogynecologic Mesh Been?

This article will detail the relative effectiveness of warnings issued by the FDA regarding Urogynecologic mesh use. According to the article, An Appraisal of the Food and Drug Administration Warning on Urogynecologic Surgical Mesh, published in Current Urology Reports (2012, 13:231-239) manufacturers market surgical mesh kits with a goal of increasing speed and ease of placement. The FDA reports over the past few years have sought to increase the awareness of the potential risks of surgical mesh when used in a transvaginal surgical procedure despite manufacturer’s claims.

More and more often reports are coming out which emphasize the fact that surgeons who use these mesh kits must have specialized training which enables them to “recognize and manage the complications of surgical mesh implants.” Governmental regulation of these mesh devices has also come under fire; while there are many different agencies in charge of regulation and reporting, women have nevertheless been harmed by transvaginally placed mesh implants. 

Relevant FDA Communications on Urogynecologic Mesh

The following article will give the reader a comprehensive overview of the FDA’s communications to date concerning surgical mesh when used transvaginally in pelvic organ prolapse surgeries. The article An Appraisal of the Food and Drug Administration Warning and Urogynecologic Surgical Mesh, published in the Current Urology Reports (2012, 13:231-239) gives an overview of the FDA’s conclusions regarding the use of surgical mesh in POP surgeries. The first Public Health Notification issued by the FDA came out in 2008 after over a thousand women submitted adverse health reports following transvaginal surgery using gynecologic mesh. Three years later the FDA issued an update to that report regarding the safety and effectiveness of mesh in POP surgery. At this time the agency reviewed the currently available safety data and scientific research on gynecologic mesh.

This article states that it is estimated that over a third of pelvic organ prolapse surgeries implement surgical mesh and that 75% of all these surgeries were done transvaginally. These numbers come from the over 300,000 women who undergo pelvic organ prolapse surgery annually in the U.S. and over 260,000 who undergo a surgical procedure for stress urinary incontinence. The FDA states that as far as SUI surgeries go, “more than 80% were done transvaginally with mesh.” The FDA’s conclusion is that although POP surgery done transvaginally may restore the woman’s body anatomically, there are few if any benefits over surgeries which do not implement urogynecologic mesh. 

Corrective Pelvic Organ Prolapse Surgery: Apical Prolapse

Apical prolapse is a disorder that affects scores of women; this article will detail a variety of surgical procedures which have been used in the past and are currently used in the treatment of apical prolapse. Based on an article in Current Urology Reports titled Surgery for Pelvic Organ Prolapse: A Historical Perspective by Barbalat and Tunuguntla (2012 13: 256-261) nearly twenty percent of all women will undergo some type of surgical procedure for treatment of apical prolapse which occurs when the uterus, cervix or vaginal floor descends, causing a variety of medical problems. Pelvic organ prolapse is a disorder which would rarely lead to death however the quality of life for the woman who experiences this disorder can be significantly diminished.

Apical Pelvic Organ Prolapse: Corrective Surgical Procedures

This article will discuss the different surgical procedures which are used when treating apical prolapse, a descent of the uterus, cervix or vaginal vault which currently affects millions of women across the globe. A recent article published in Current Urology Reports titled Surgery for Pelvic Organ Prolapse: A Historical Perspective by Barbalat and Tunuguntla (2012 13: 256-261) described the three current transvaginal techniques to repair apical prolapse: “Transvaginal techniques to correct apical prolapse include sacrospinous vault suspension, iliococcygeus suspension and uterosacral vault suspension.” The article also noted that a technique known as the McCall culdoplasty reattaches the uterosacral ligaments to the back wall of the vagina following a hysterectomy. The original McCall repair used three uninterrupted permanent sutures across the midline which prevents or corrects enteroceles.

Corrective Surgical Procedures for Apical Prolapse

This article will discuss the various surgical procedures currently used in the treatment of apical prolapse. Apical prolapse is the descent of uterus, cervix or vaginal vault and affects millions of women worldwide. By the age of 80 to 85 years, as many as 19 percent of women will have undergone a surgical procedure to correct pelvic organ prolapse or stress urinary incontinence.

According to an article in the Obstetrics and Gynecology Board Review Manual titled Diagnosis and Treatment of Vaginal Apical Prolapse, “As the average life span of the population increases, problems related to pelvic support defects are seen with increasing frequency in women.”