I talk a lot about mesh for incontinence surgeries.  Women have so many questions.  Many rumors and stories exist, some true, many not relevant.  There is a lot of fear and confusion around mesh and for good reason.  Here’s why: Mesh can be used to correct bladder leaking as well as prolapse.  These surgeries are very different.  They have different risks, benefits and possible complications.  The mesh controversy really focused on vaginal mesh prolapse repairs and NOT incontinence surgery.  These vaginal mesh prolapse repairs had unique complications and are a whole separate topic.  But in some reporting, incontinence surgeries and vaginal mesh prolapse repairs were lumped together.  This lumping created a lot of confusion.  I am focusing only on mesh slings used in incontinence surgeries.  And the current concensus joint statement on mesh slings.

A little background

In 2022, a joint statement was published on mesh slings for bladder leaking.  There had been so much negative media attention on mesh that both doctors and women were feeling nervous.  While I know and understand the data- joint statements makes everyone feel better.  When the thought leaders in my field agree with me, it supports my recommendations (no one wants a rogue doctor).  This joint statement is an amazing feat- 7 different organizations agreed on the statement.  These 7 groups, all thought leaders in the field of incontinence surgeries, agreed and supported the statement.  I can’t tell you how rare it is to get this many doctors to agree on one treatment, especially one that has been clouded by negative media attention (even if it wasn’t warranted).  This just demonstrates how much we all believe in the therapeutic benefit of mesh slings. These 7 organizations (American Urogynecologic Society, Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction, American College of Obstetrics & Gynecology, American Urological Association, American Association of Gynecologic Laparoscopists, National Association for Continence, International Urogynecological Association, Society of Gynecologic Surgeons) all said the following (and I am paraphrasing but you can see the full statement through the link below):

What the joint statement says

The mesh used in mesh slings is safe and effective.

We’re not just throwing this out there.  There is a ton of data to support this statement.  Studies have shown that mesh slings work and women are satisfied.  And that mesh slings last up to 17 years (they do not fail after 17 years but we are still gathering the longer term data).

These mesh surgeries for leaking are the most studied incontinence surgeries ever.

We were worried about these surgeries.  Mesh had never been used in the pelvis in this way.  So we studied it.  Like, a lot.  There is a huge amount of high quality data examining these mesh slings in all different ways.  And we are really satisfied with the results.

Mesh surgeries are the standard of care for incontinence surgeries.

We believe they are the standard of care because the research shows they work AND women have less pain,have a quicker recovery, spend less time in the hospital and mesh slings are more cost-effective.  Who doesn’t want a quick, easy,and cheaper surgery?

Both the FDA and the European Commission agree with these statements.

There was a time when the FDA and European commission paused to gather more data on these surgeries.  They wanted to make sure that they were safe and effective.  They reviewed all of the data and research and now agree on the safety and effectiveness.  The European Commission does recommend that the surgeon is well trained and experienced, which only makes sense.  There is a lot of data that shows that surgeons who do a consistent volume of surgery are better at it.

Conclusion

The conclusion from this joint statment?  Mesh slings for bladder leaking have helped millions of women with bladder incontinence.  One of the consequences of the pelvic mesh controversy is that women stopped seeking care for their incontinence.  And they can be reassured that this is a safe and effective surgery.  So you can be comfortable talking to a surgeon about this type of surgery.  It works.   I haven’t treated millions of women but I have treated thousands.  Women do well.  Their leakage is cured or much better.  My patients who have this type of surgery are busy, active women who feel limited by their stress incontinence.  Women like you.  Go and have the conversation.  See if it suits you. Joint position statement on midurethral slings for stress urinary incontinence. Neurourology and Urodynamics. 2022;41:31-34