Let's talk so we can make informed decisions with our doctors regarding surgical interventions to repair POP and SUI.   But in order to talk with understanding, and knowledge we should know the following scientific facts provided by  Ateş Karateke M.D. ,Istanbul. 
                  ( the next post will feature information from Dr. Ostergard)






 •Meshes have been used in the management of stress
                   urinary incontinence since 1996


           

                                                   Few Randomized Clinical Trials

                      • Few randomized clinical trials comparing subjective and objective cure rates of                      

                        mesh  augmented repairs with traditional repairs 

                      • Minutes after insertion there is a race for the surface of the mesh between host      

                        cells and bacteria

                      • If the host cells win then the surface is protected from bacterial colonization

                      • If the bacteria win and manage to secrete their slime that envelopes them so that  

                        host defenses cannot get to them then the mesh is irreversibly contaminated

                      • These bacteria can remain quiescent for long periods of time with the possibility of                         

                        establishing an actual tissue infection at any time

Gristina AG.Biomaterial –centered infection:microbial adhesion versus tissue integration.Science

1987;237:1588-95

           Ostergard Mesh Erosion Compared With Tissue Incorporation VOL. 116, NO. 4,OCTOBER 2010

                                                       Large Surface Areas

                     • The surface area of the mesh is important in determining levels of bacterial        

                       contamination

                                             – more polypropylene degradation

                                                – increased inflammatory response

                                                  – fibrous tissue stimulation

                      Culligan P.Bacterial colony counts during vaginal surgery.

                                           Infect Dis Obstet Gynecol 2003;11:161-5

                                                  Polypropylene Is Not Inert

                                    • Polypropylene is not inert within the human body

                           • Oxidation of meshes when exposed to the milieu of the human body does occur

                                   – because macrophages secrete acidic compound

                                                           • hydrogen peroxide

                                                           • hypochlorous acid

Clave H, Polypropylene as a reinforcement in pelvic surgery is not inert:comparative analysis of 100

                                   explants.Inf Urogynecol J 2010;21:261-70

                                                            Degradating Rate

                                • 33.3% (21.4%-47.8% depending on density)of monofilament polypropylene

                                                            – Macroporous

                                                            – Low-weight

                                                      – Small-caliber fiber diameter

                                     • 75% of multifilament polypropylene meshes

                   Clave H, Polypropylene as a reinforcement in pelvic surgery is not

         inert:comparative analysis of 100 explants.Inf Urogynecol J 2010;21:261-70

                                                                 IS IT SAFE?

                                       • The use of synthetic mesh is not without complications

                     • Mesh-related complications could have significant impact on the quality of life

                                                     Mesh-Related Complications

                                                    – Vaginal mesh exposure

                                                    – Vaginal mesh extrusion

                                                    – Dyspareunia

                                                    – Pelvic/bladder/urethral pain

                                                    – Obturator nerve damage

                                                    – Pelvic neuropathy

                                              –  Recurrent prolapse

Mesh-Related Complications

• Vesicovaginal or urethrovaginal fistula

• Wound infections

• Recurrent urinary tract infections

• Visceral injuries to bowel,bladder and ureter

• Contraction/Fibrosis

• De novo stress urinary incontinence

• Detrusor overactivity