incontinence and performed about 550 mesh prolapse repairs.
"Overall, these patients do very, very well," he says. But, he acknowl-
edges, other physicians have not been as successful.
"Admittedly, some patients have had big problems, and — full dis-
closure — I've been involved as an expert for the defense in many of
these cases," he says. "But in almost every case I've looked at, it's not
a problem with the product. It's a problem with how the product was
used. Most cases involved someone not very experienced placing
these products, and doing it incorrectly. Mesh doesn't erode into the
bladder, it doesn't erode into the urethra. It was placed there in the
first place and the doctor just didn't know it."
It comes down to which physicians should be doing these cases,
and which shouldn't, says Dr. Feagins, even suggesting that surgical
facilities closely regulate who can implant vaginal mesh. "Maybe you
should have to demonstrate that you've been proctored for a certain
number of cases," he says.
"It looks easy … and it is easy to me," he adds. "But to somebody
who's not doing the procedure a lot, that may be a recipe for disaster."
Should physicians have been more wary of vaginal mesh at the out-
set?
"I don't think anybody foresaw what was going to transpire," says
Thomas L. Lyons, MD, MS, FACOG, of Advanced Gynecology Associates
in Conyers, Ga. "But any time you place a foreign material in the body,
there could be consequences." He also notes that clinical data support
the use of mesh in suburethral slings. "It is the gold standard," he says. "It
delivers as good a result as you're going to get for urinary stress inconti-
nence."
Dr. Feagins agrees. "There's zero question that mesh-based slings are
the gold standard for treatment of stress incontinence in 2016 and have
been for the last 10 years," he says. "People have short memories
4 0 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A U G U S T 2 0 1 6
