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UPJ INSIGHT: Would Surgeons Opt for Polypropylene Mesh if They Hypothetically Had Stress Urinary Incontinence or Pelvic Organ Prolapse?

By: William J. Devan, MD; Dayron Rodriguez, MD, MPH; Ricardo Munarriz, MD; Linda Ng, MD; Sanchita Bose, MD | Posted on: 01 Jul 2022

Devan WJ, Rodriguez D, Munarriz R et al: Would surgeons opt for polypropylene mesh if they hypothetically had stress urinary incontinence or pelvic organ prolapse? Urol Pract 2022; 9: 306.

Figure. SUI (left) and POP (right) treatment preferences. Preferences are represented as percentage of providers who prefer each modality. Asterisks indicate p <0.001, a significantly greater proportion of providers would prefer this treatment preference compared to the other treatment modalities. PFPT, pelvic floor physical therapy. PT, physical therapy.

Study Need and Importance

Polypropylene mesh, although widely used in female pelvic medicine, continues to be a controversial issue. Given its negative association with transvaginal mesh kits which were reclassified as high-risk devices by the U.S. Food and Drug Administration in 2011, many patients continue to express hesitation about polypropylene mesh, even for mesh with approved use in mid-urethral slings for stress urinary incontinence (SUI) and mesh used for transabdominal sacrocolpopexy for pelvic organ prolapse (POP)—both of which are endorsed by both SUFU (Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction) and AUGS (American Urogynecologic Society).

What We Found

This paper is important because it provides a comprehensive yet succinct history of the controversy surrounding polypropylene mesh use in female pelvic surgery. We hope that the primary findings of our paper—that surveyed female pelvic medicine surgeons from both SUFU and AUGS (141 participants) would prefer synthetic mid-urethral slings for hypothetical SUI (69%, p <0.001) and transabdominal sacrocolpopexy for hypothetical POP (27%, p <0.001; see Figure)—may assuage some of the fears and negative connotations patients may have regarding the appropriate use of mesh in female pelvic surgery.

Limitations

Our study is not free from limitations. Primarily, our survey instrument was not validated, and our response rate is 20%, which is on the low range of normal for an email survey.

Interpretations for Patient Care

However, we hope that this paper will serve as a resource for female pelvic medicine providers counseling patients about the appropriate use of mesh in female pelvic surgery. Our hope is that it achieves this goal through its succinct history of the polypropylene mesh controversy issue as well as possibly normalizing the experience of mesh use in female pelvic surgery by knowing their own surgeon would likely opt for this intervention if they hypothetically experienced the same issue.