The use of vaginal mesh continues to spur debate within the urology field. This afternoon, four experts in female pelvic medicine will discuss one controversial area of the ongoing debate during a Crossfire: Controversies in Urology session titled Vaginal Mesh Should be Removed by Radical Meshectomy, which will begin at 1:30 p.m. during the Prime Time II plenary session in Ballroom East of the Boston Convention and Exhibition Center.
Victor Nitti, MD, professor and Vice Chair of the Department of Urology and Head of Female Pelvic Medicine and Reconstructive Surgery at New York University Langone Medical Center, will moderate the 30-minute debate.
“Even though vaginal mesh for pelvic organ prolapse repair is not used as much as it was in the past, there are still a number of patients who have it and continue to present with complications years after their initial surgery,” Dr. Nitti said. “Urologists still commonly see issues with the mesh eroding or causing pain. Less commonly, we see infection. No matter the problem, urologists must have a plan for addressing it.”
Shlomo Raz, MD, Chief of the Division of Pelvic Medicine and Reconstructive Surgery at the University of California Los Angeles School of Medicine, and Christian Twiss, MD, Director of Female Urology, Pelvic Medicine, and Pelvic Reconstructive Surgery at the University of Arizona College of Medicine, will make the case that vaginal mesh should be removed by radical meshectomy.
“Drs. Raz and Twiss will argue that, if you don’t get all of the mesh out, you’re likely to have a persistent problem,” Dr. Nitti said. “And, if you try to go back in to remove more mesh later, it’s more difficult than taking it all out from the start.”
Elizabeth Takacs, MD, clinical associate professor of Urology at the University of Iowa Carver College of Medicine, and Howard Goldman, MD, FACS, professor at the Cleveland Clinic Lerner College of Medicine, will argue against the need for radical meshectomy. “
Drs. Goldman and Takacs will argue that there’s good data to suggest that, if you remove just the portion that’s causing the problem — whether it’s pain or an eroded segment — the vast majority of the time you will be able to relieve the problem,” Dr. Nitti said. “They will argue that the more you remove, the more potential you have for de novo problems related to the removal of the mesh.”