Opinion: Yes
نویسندگان
چکیده
Nowadays, synthetic meshes are widely used in reconstructive surgeries of the pelvic floor. However, since the publication of the FDA warning about associated complications in 2011 (1), several discussions and contrary opinions have been published about its usefulness. The fear of court lawsuits related to side effects, common in some settings, has contributed to the widening of global discussion. Doubtless, these slings are associated to specific complications, such as exposition and erosion, and impact on sexual performance of treated patients. However, the big question is: is the use of meshes in pelvic surgery always problematic? a) The use of mesh to treat prolapses is equal to its use in stress urinary incontinence? b) Is the use of these slings in the correction of prolapses of different grades and positions the same? In other words, is it possible to expand the complications rates from one indication to others, and vice-versa? When we evaluate the history of the use of slings in reconstructive surgery of the pelvic floor, this reasoning of generalization was used since the beginning. Slings were introduced as a minimal invasive procedure without the need of incisions to reach healthy tissues, with good results and low rate of complications at long follow up. The use of meshes was widened to include the treatment of pelvic prolapses with a valid theoretic reasoning that conventional surgeries showed high rates of recurrence (2). This fact corresponded to the beginning of use of the same materials in large scale. Urologists and gynecologists started to progressively employ these meshes frequently with low training. After some years, the complications emerged. Publication of results of the use of meshes in the treatment of pelvic prolapses by several authors justified the positioning of FDA (1). In that document, the agency cited 10% of exposition/erosion of meshes in patients treated for pelvic prolapses inserting the mesh vaginally after 12 months of surgery (3). However, in some studies, this rate was even higher, reaching almost 33% (4). On the other hand, the incidence of erosion/exposition of mesh in the abdominal correction of prolapses is inferior, around 4%, in a follow up of 23 months (5), implying that the access way and not only the use of meshes is related to the high level of observed complications. DIffERENCE Of OpINION
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