|Shortly after the trial against the pharmaceutical company Ethicon (Johnson & Johnson) in Australia came to an end, accompanied by a strong media response, the links to a relevant report were already shared in the German social media. The enquiries received by the German Continence Society in recent days also testify to the interest of those affected here – and to their uncertainty.
It is about the health fate of thousands of women who have had polypropylene nets used to treat sedimentation or prolapse. This particularly affects women after natural births, older women and obese women. With the help of the nets fixed to the sacrospinal ligament, for example, the uterus is protected from further prolapse after uterus prolapse. Another application of very narrow net bands is the treatment of stress incontinence. Here the tension-free implantation of a band under the urethra represents the gold standard.
|A recently published long-term study shows that 9 years after a loop operation only 1.1% of the ligaments had to be revised due to stress incontinence – which may prove the low-complication, long-term success (Obstet Gynecol 2019). Therefore, the net debate about prolapse operations should not be confused with incontinence treatment.
In the case of prolapse treatment, classic techniques without the use of nets show significantly higher complication rates in some cases. However, when these were practiced more than 20 years ago, there was hardly any demand for criteria such as quality of life and their failure rate was not documented in detail. Experts now fear that the mesh debate from the Anglo-American region could also lead to politically motivated bans or restrictions elsewhere. And this would leave hardly any options for the women concerned.
There is no reason to worry about a net treatment, as net implantation is still the therapy of choice if the indication is correct and experienced urogynaecologists are in hand. “Of course not without first exploiting the entire spectrum of conservative measures, especially for younger patients,” said a pelvic floor specialist. This includes appropriate training measures offered by qualified physiotherapists.
It´s different, however, if symptoms differ after vaginal mesh insertion. “If the patient has pain, perhaps at rest or during sexual intercourse, or bleeding from the vagina, she should consult a specialist.” (Fink). The specialist could detect signs of erosion and establish contact with a pelvic floor centre. Here one should return to where the net was placed in order to decide whether it should be removed. German urogynaecologists are currently trying to establish a register that documents the net complications in order to better record risk factors.
|mls/aerzteblatt.de||aerzteblatt.de, 2 dec 2019 (german)|
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