What a mesh! An Australian experience using national female continence surgery trends over 20 years

McVey, Aoife; Qu, Liang G.; Chan, Garson; Perera, Marlon; Brennan, John P.; Chung, Eric; Gani, Johan

doi:10.1007/s00345-021-03691-9

Cited by 5 publications

(6 citation statements)

References 23 publications

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“…However, it is much more likely that this decrease was due to Australian women being reluctant to consider any type of mesh usage for prolapse surgery. This was associated with FDA notifications between 2008 and 2016 and the ARTG decision to remove mesh from the registry in 2017 22 which showed a similar decline in usage of mid‐urethral sling mesh in Australia which is used to treat SUI 23 …”

Section: Discussionmentioning

confidence: 99%

“…21 However, it is much more likely that this decrease was due to Australian women being reluctant to consider any type of mesh usage for prolapse surgery. This was associated with FDA notifications between 2008 and 2016 and the ARTG decision to remove mesh from the registry in 2017 22 which showed a similar decline in usage of mid-urethral sling mesh in Australia which is used to treat SUI. 23 In 2018 the ACSQHC led the development of guidance documents for the hospital credentialing of senior medical practitioners to undertake transvaginal mesh surgery, with an aim to ensure the safety of patient care.…”

Section: Discussionmentioning

confidence: 99%

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Australian trends in the treatment of pelvic organ prolapse in the non‐mesh era

Mollah

Brennan

2023

ANZ Journal of Surgery

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Background To assess the contemporary trends in the types and incidence of pelvic organ prolapse (POP) surgery in Australia after the removal of transvaginal mesh from the Australian market. Methods This was a retrospective Australian cohort study utilizing three large Governmental databases covering all private and public POP procedures in Australia. All females ≥25 years old undergoing POP procedures between 2005 and 2021 were included. Results From 2005–2006 to 2020–2021 there have been a total of 408 881 POP procedures in Australia. The total number of procedures peaked in 2005–2006 at 537.8 procedures per 100 000 age‐standardized female population, decreasing by an average of 3.5% per year to 329.0 procedures per 100 000 in 2018–2019, an overall 38.8% decrease (P < 0.001). A sudden growth in private operative procedures was noted between 2019–2020 and 2020–2021, from 218.2 to 268.6 procedures per 100 000 population, a 23.1% increase (P < 0.001). Laparoscopic and abdominal POP repair has seen a 115.8% increase from 13.7 procedures to 29.6 per 100 000 between 2005–2006 and 2020–2021. Over the last 15 years, the most common age group to undergo a procedure has changed from the 55 to 64 years demographic to a later decade of 65 to 74 years. Conclusion Over the last 15 years, the total number of POP procedures performed has significantly decreased. There has however been a recent rise in interventions seen in the private sector and the utilization of laparoscopic or abdominal POP repair has increased, which has implications for procedural credentialing to ensure patient safety.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Australian trends in the treatment of pelvic organ prolapse in the non‐mesh era

Mollah

Brennan

2023

ANZ Journal of Surgery

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“…The PICO statement for this systematic review is as follows: in patients submitted to synthetic sling procedures for STU who experienced mesh erosion into the urinary system (bladder and/or urethra), what is the success rate of cystoscopic laser excision in terms of complete mesh removal proven during a follow-up cystoscopy after a single or additional procedures [11–39].…”

Section: Methodsmentioning

confidence: 99%

Should endoscopic laser excision be offered as the first-line management for patients with eroded mesh? Outcomes of a systematic review of literature

Ripa,

Enikeev,

Talyshinskii

et al. 2023

Current Opinion in Urology

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Purpose of review Mesh erosions following previous synthetic sling/mesh surgery for stress urinary incontinence (SUI) have become increasingly common. This systematic review provides evidence for the role of laser excision as a first-line management in patients with eroded mesh. Recent findings Fourteen articles (173 patients) were included for the final review. Among these, 138 patients (79.8%) were submitted to trans-urethral laser excision of eroded urethral/bladder mesh over a median time to presentation of 36.6 months. Over a median follow-up of 23.6 months, 88 (63.7%) reported a complete resolution, 32 (23.2%) reported persistence or recurrence of SUI and 17 (12.3%) presented with recurrent mesh erosion. The success rate after a single endoscopic procedure was 66.5, vs. 93.5% after additional endoscopic procedures, with only 9 (6.6%) requiring open surgical excision. Overall, there were seven (5.1%) postoperative complications including two urethrovaginal fistulas, two UTIs and haematuria each, and one case of urethral diverticulum. Summary Laser excision of eroded mid-urethral slings into either the bladder or urethra is a challenging complication of minimally invasive incontinence surgery. Laser excision was able to achieve a good success rate with single or staged endoscopic procedure with a low risk of complication. It represents a valid first treatment option, although patients should be managed in mesh referral centres in collaboration with uro-gynaecology teams.

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“…Nevertheless, recent reports about possible risks related to mesh surgery from several official organisms around the globe (FDA, SCHENIR) [ 6 , 7 ] determined rising concern about the safety of this kind of surgery in clinical activity. Therefore, the use of synthetical prostheses in the treatment of female SUI has been widely reevaluated and limited during the last years [ 8 , 9 ]. Hence, a renewed interest in alternative intervention for the treatment of female SUI has occurred.…”

Section: Introductionmentioning

confidence: 99%

Urethral Bulking in the Treatment of Stress and Mixed Female Urinary Incontinence: Results from a Multicenter Cohort and Predictors of Clinical Outcomes

Giammò

Geretto

Ammirati

et al. 2022

JCM

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The aim of the present study is to analyze the outcomes of urethral bulking in the treatment of non-neurogenic female stress and mixed urinary incontinence and to assess predictors of clinical outcomes. We retrospectively included all consecutive patients affected by stress or mixed urinary incontinence and treated with urethral bulking. Outcomes were evaluated via the PGI-I questionnaire and the 24-h pad test. Between January 2010 and January 2020, we treated 216 patients (Bulkamid n = 206; Macro-plastique n = 10). The median age at surgery was 66 years (IQR 55–73.75). The median follow-up was 12 months (IQR 12–24). In total, 23.8% of patients were subjected to prior incontinence surgery, 63.8% of patients were affected by genuine stress urinary incontinence, 36.2% reported mixed urinary incontinence, whereas detrusor overactivity was confirmed in only 24.9%. The dry rate was 32.9%; nevertheless, 69.9% of patients declared themselves “very improved” or “improved” (PGI-I1-2). Low complications were observed, mostly classified as Clavien I. After univariate and multivariate analyses, the only statistically significant independent predictor of “dry” outcome was the 24 h pad test, p < 0.001. Urethral bulking could be proposed with more expectations of success in patients with mild urinary incontinence. Patients affected by moderate–severe incontinence are less likely to obtain clinical success; therefore, they should be carefully counselled about clinical expectations before the procedure.

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What a mesh! An Australian experience using national female continence surgery trends over 20 years

Cited by 5 publications

References 23 publications

Australian trends in the treatment of pelvic organ prolapse in the non‐mesh era

Australian trends in the treatment of pelvic organ prolapse in the non‐mesh era

Should endoscopic laser excision be offered as the first-line management for patients with eroded mesh? Outcomes of a systematic review of literature

Urethral Bulking in the Treatment of Stress and Mixed Female Urinary Incontinence: Results from a Multicenter Cohort and Predictors of Clinical Outcomes

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