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Clinical Views

FDA Reports to Patients on Risks of Vaginal Mesh
March 27, 2013

The FDA wants patients with pelvic-organ prolapse to know that having a surgery with transvaginal mesh may put you at risk for needing additional surgery, and in some cases, repeat surgery may not resolve complications. Click here for the full patient advisory PDF.

Controversies in the Field of Urogynecology: Mesh Used in Vaginal Surgery

Message from the Urogynecology Division, Department of Obstetrics and Gynecology, Mount Sinai St. Luke’s and Mount Sinai West

An ongoing public controversy was stimulated by the FDA’s 2011 warning regarding the use of synthetic mesh in vaginal surgery for prolapse.

As a matter of fact, departmental urogynecologists Lisa Dabney, MD, and Anne Hardart, MD, have never used much mesh in their practices. They have been especially reluctant to use mesh to augment pelvic-organ-prolapse repairs performed through the vaginal route. Fortunately, they have extensive expertise in performing these procedures vaginally without the use of mesh—and they have had excellent results.

However, Drs. Dabney and Hardart do agree that there is occasionally a role for certain types of mesh in the surgical treatment of urinary incontinence and pelvic organ prolapse. They have used synthetic slings in the treatment of stress urinary incontinence in over 700 patients with excellent results and extremely low complication rates. In addition, mesh placed by the abdominal route has a well-defined role with low risk. Lastly, vaginal mesh may have a role in a certain few patients with recurrent prolapse.

If you begin a doctor-patient relationship with either of them, you can feel confident that Drs. Dabney and Hardart will have a long discussion with you about your problems and what approach is best for you. These urogynecologists consider each case carefully to make sure that each patient gets the procedure that is right for her.

Find out more about these doctors, the Urogynecology Division, and the Department of Obstetrics and Gynecology at Mount Sinai St. Luke’s and Mount Sinai West.


Urogynecology Physicians

Urogynecology Physicians

Special Interests

OB Gyn Gynecology St. Luke's Hospital New York Manhattan Pregnancy Risks Specialist Midwife Physicians Lisa Dabney, M.D.
  • Surgical and nonsurgical management of pelvic organ prolapse and urinary incontinence
  • Laparoscopic surgery
  • Sexual dysfunction among patients with multiple sclerosis
OB Gyn Gynecology St. Luke's Hospital New York Manhattan Pregnancy Risks Specialist Midwife Physicians Anne Hardart, M.D.
  • Surgical and nonsurgical management of pelvic organ prolapse and urinary incontinence
  • Laparoscopic surgery
OB Gyn Gynecology St. Luke's Hospital New York Manhattan Pregnancy Risks Specialist Midwife Physicians Chandhana Paka, M.D., FACOG
  • Surgical and nonsurgical treatment of pelvic organ prolapse and urinary incontinence
  • Surgical and nonsurgical treatment for interstitial cystitis, high tone pelvic floor and pudendal neuralgia
  • Specialty training in minimally-invasive gynecologic surgery, including advanced laparoscopy and robotics
  • Provides treatment of benign gynecologic conditions including fibroids and endometriosis

OB Gyn Gynecology St. Luke's Hospital New York Manhattan Pregnancy Risks Specialist Midwife Physicians Home
OB Gyn Gynecology St. Luke's Hospital New York Manhattan Pregnancy Risks Specialist Midwife Physicians Contacts
OB Gyn Gynecology St. Luke's Hospital New York Manhattan Pregnancy Risks Specialist Midwife Physicians Clinical Services


OB Gyn Gynecology St. Luke's Hospital New York Manhattan Pregnancy Risks Specialist Midwife Physicians Division Overview
OB Gyn Gynecology St. Luke's Hospital New York Manhattan Pregnancy Risks Specialist Midwife Physicians Physicians
OB Gyn Gynecology St. Luke's Hospital New York Manhattan Pregnancy Risks Specialist Midwife Physicians Appointments
OB Gyn Gynecology St. Luke's Hospital New York Manhattan Pregnancy Risks Specialist Midwife Physicians Types of Urinary Incontinence
OB Gyn Gynecology St. Luke's Hospital New York Manhattan Pregnancy Risks Specialist Midwife Physicians About Prolapse
OB Gyn Gynecology St. Luke's Hospital New York Manhattan Pregnancy Risks Specialist Midwife Physicians Treatments for Incontinence & Prolapse
OB Gyn Gynecology St. Luke's Hospital New York Manhattan Pregnancy Risks Specialist Midwife Physicians Minimally-Invasive Surgery for Other GYN Problems

Types of Urinary Incontinence

Your doctor will work with you to determine the type of incontinence, so that you can receive appropriate therapy.

Stress Incontinence: Loss of urine during exertion, such as coughing, laughing, or running.

Urge Incontinence: Loss of urine for no apparent reason after suddenly feeling the need or urge to urinate.

Mixed Incontinence: A combination of stress and urge incontinence.

About Pelvic Organ Prolapse

Pelvic organ prolapse is the dropping or falling of the uterus, bladder, rectum, or vagina.



Uterine Prolapse: Pelvic support structures break down and the uterus drops into the vagina. Most often, other organs are also out of place.

Anterior wall prolapse, or cystocele: This is the most common type of pelvic floor defect. The bladder drops and rotates into the vaginal opening, and sometimes bulges out. Some cystoceles can cause urine leakage while large cystoceles can cause difficulty voiding.

Posterior wall prolapse, or rectocele: This condition can result in the rectum bulging into the vaginal opening. A large rectocele can make it difficult to move the bowels.
 
Pelvic prolapse images and captions
used by permission of Ethicon Women’s Health and Urology, a Johnson and Johnson Company.

Treatments for Incontinence & Prolapse: