|January 2009 · Vol. 21, No. 01
ROUNDTABLE: PART 1 OF 2: Using mesh to repair prolapse calls for more than a kit—it takes skill
Mesh augmentation isn’t right for every prolapse repair—or every surgeon. When it is called for, mesh necessitates extra training, meticulous technique, and careful selection of patients.
Dr. Karram receives research support from Ethicon Women’s Health and Urology, Allergan, and Biosante and is a consultant and speaker for Astellas, Ethicon Women’s Health and Urology, and CooperSurgical. He has a financial interest in Emedsco.
Dr. Lucente receives grant or research support from and consults for Ethicon, AMS, and Bard and is a speaker for Ethicon and Bard.
Dr. Raz reports no financial relationships relevant to this article.
Dr. Walters is a consultant and speaker for AMS and Boston Scientific.
THE OBG Management EXPERT PANEL
MICKEY M. KARRAM, MD, moderator, is Director of Urogynecology at Good Samaritan Hospital and Voluntary Professor of ObGyn at the University of Cincinnati School of Medicine in Cincinnati, Ohio.
SHLOMO RAZ, MD, is Professor of Urology and Chief of Pelvic Medicine and Reconstructive Urology at UCLA School of Medicine in Los Angeles.
VINCENT LUCENTE, MD, MBA, is Founder and Director of the Institute for Female Pelvic Medicine and Reconstructive Surgery in Allentown, Pa, and Clinical Professor of ObGyn at Temple University School of Medicine in Philadelphia.
MARK D. WALTERS, MD, is Professor and Vice Chair of Gynecology, Section of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, at the Cleveland Clinic in Cleveland, Ohio.
Mesh kits for repairing prolapse are proliferating like crazy, just as they did for midurethral sling procedures. But mesh augmentation of prolapse surgeries requires more than a prepackaged assortment of tools and materials. In this article, moderator Mickey M. Karram, MD, and a panel of nationally recognized urogynecologists and urologists describe the literature on mesh augmentation and discuss indications, contraindications, techniques, applicable cases, and the considerable training required.
In Part 2, which will appear in the February issue of OBG Management, the panel tackles the thorny topic of complications, including erosion, extrusion, foreshortening of the vagina, dyspareunia, and pain. Their discussion focuses on ways to avoid these problems, and methods for correcting them.