With all of the controversy, bad outcomes, and thousands of personal injury lawsuits concerning vaginal mesh, this medical doctor has a novel approach. Dr. John Wei of the University of Michigan suggests using a mid-urethral sling to prevent incontinence, even when the woman is not incontinent!

Published June 20, 2012 in the New England Journal of Medicine, Dr. Wei says, “What we found is that by putting in a sling, the risk of having leakage is halved,” he says.

A sling is inserted vaginally at the time of prolapse surgery when weak muscles and tissues allow organs to prolapse or fall into the vagina.  At the time of the prolapse surgery, Dr. Wei adds the extra mesh to lift the bladder for a prophylactic or preventive measure to prevent incontinence that may or may not occur after the surgery. 

“There have been two schools of thought: put in a sling as a preventive measure when we put the bladder back up, or wait until there is a problem and then fix it,” often with surgery, said Wei. “What we found is that by putting in a sling, the risk of having leakage is halved.”

In the study, Dr. Wei involved 337 women who were scheduled for prolapse surgery. Half were treated with the Gynecare TVT sling, made by Ethicon, a division of Johnson & Johnson (J&J).  After three months, only 23.6% of the sling recipients had developed incontinence while 49.4% without the sling had urinary incontinence. 

Dr.  Wei says the benefits lasted for the full year the women were followed and they will outweigh the risks for most patients. However, a one-year follow-up is hardly enough time to reveal how many women may eventually suffer complications from the plastic mesh sling such as infection, mesh migration, perforation, nerve damage, among other complications.

Dr. Wei does admit that 7% of the women with the sling had a bladder perforation while 31% of the women with slings had urinary tract infections compared to 18.3 % of those without the sling.

It sounds like good promotion for Ethicon but Dr. Wei’s funding comes from the U.S. National Institute of Child Health and Human Development and the National Institutes of Health Office of Research on Women’s Health. Bloomberg reports J& J was not involved in the study by providing funding or the devices used.

While it might be tempting to use the latest and greatest “gold standard” it is not without risks and women need to be fully informed that fixing a problem before it develops may lead to greater complications down the road.

 

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