Vim & Vigor - Fall 2017 - University of Virginia - 55

MEET THE UVA
PELVIC MEDICINE
TEAM
Regain your health,
confidence and
quality of life with
the region's most
complete female
pelvic medicine
program.
From left:
Elisa Trowbridge, MD,
Kathie Hullfish, MD,
and Megan Dillman,
MSN, WHNP
(women's health
nurse practitioner)

Clearing Up
the Mesh
Controversy

PHOTO BY KAY TAYLOR, UVA HEALTH SYSTEM

f you have urinary incontinence,
you're not alone. At least half of
all women over age 40 have some
form of this medical condition.
For the most common type-stress
incontinence-treatment usually starts
with physical therapy and lifestyle
changes. But if these methods don't
help, a surgeon can place a synthetic
sling to support the urethra (tube that
urine passes through). Experience
and research with sling surgery have
consistently demonstrated good outcomes and very low risk.
Sling surgery is not the same thing
as vaginal "mesh" surgery. For many
women, hearing the word, "mesh"
is frightening. That's because in the
past decade, the U.S. Food and Drug
Administration has issued safety warnings about transvaginal surgical mesh
to repair pelvic organ prolapse (when
organs fall into the vagina). Most of

those vaginal mesh products have
been removed from the market and
are no longer used.

Don't Put Up with
Stress Incontinence

Today's sling approach for stress
incontinence is a 25-minute outpatient
procedure. "It is safe and has a 75 to 90
percent success rate. It's really changed
the treatment for severe stress incontinence. You no longer have an overnight
hospital stay and long recovery," says
Kathie Hullfish, MD. "I hear over and
over again from so many women, 'I wish
I had done this sooner.'"

Safer, More Effective
Prolapse Surgery

For women who need surgery for
prolapse, there are safe and effective
options-that often don't use the surgical mesh. "Our first go-to recommendation is not to use the mesh but to use a
woman's own tissues to support her pelvic organs," says Elisa Trowbridge, MD,
a UVA board-certified and fellowshiptrained urogynecologist. "This is the
tried-and-true method and is 85 percent
effective in the hands of experienced surgeons who do a lot of these surgeries."

As leaders in the field, Drs.
Trowbridge and Hullfish perform
nearly 400 pelvic reconstructive
surgeries each year.
"Complications are extremely rare,"
Trowbridge says, especially now that
UVA offers an Enhanced Recovery After
Surgery Program. Simple measures
(walking the night of surgery and eating soon after surgery) typically result
in shorter recovery times and improved
patient experience, research shows.
A few times each month, Trowbridge
and Hullfish remove the mesh causing
pain and other complications for women
who had a transvaginal prolapse procedure done elsewhere. "We still see these
complications but far fewer than several years ago when we saw about 100
women each month," Trowbridge says.
The main problem with the transvaginal mesh procedure, according to the
American Urogynecologic Society, was
that many doctors started performing these procedures without adequate
training and didn't have experience
in reconstructive pelvic surgery. The
FDA recommends that its placement
"be used cautiously by experienced
surgeons with extensive training in
pelvic surgery." ■
FALL 2017

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