| SAUGA NEWSLETTER | JULY 2017 |
From The Editor:
In a few short weeks we have the SAUGA Durban 2017 Congress and this promises to be a splendid exciting meeting. In the meantime we can offer an exciting newsletter packed with relevant Clinical information. See you in Durban
Message from the President:
Dear Colleagues
Yet again the use of mesh for pelvic organ prolapse (POP) surgery and stress urinary incontinence (SUI) is under scrutiny. Early this year an Australian Federal Parliamentary inquiry on the safety of mesh for POP and SUI prompted a class action suit against Johnson and Johnson, and the lack of pre-market clinical testing by the Therapeutic Goods Administration (TGA) was also questioned. Locally, the newly established South African Health Products Regulatory Authority (SAHPRA) will now be responsible for regulating medical devices in SA. We attach the SAUGA position statement on this emotive issue.
Dr Lisa Kaestner has prepared as excellent review on urinary tract complications with relevance to pelvic surgery. Although the ureters are uniquely positioned, ureteric (and bladder) injuries are not uncommon. Early diagnosis and appropriate management is key as delayed diagnosis can result in more significant complications. See you in Durbs!
Yours sincerely
Dr Zeelha Abdool
SAUGA President
“Either write something worth reading or do something worth writing’’-Benjamin Franklin
The Use of Mesh Implants in Vaginal Prolapse Surgery:
Position statement and recommendations of the South African Urogynaecology AssociationDr EW Henn, MMed (O&G), FCOG (SA), on behalf of the executive of the South African Urogynaecology Association
Introduction
Pelvic organ prolapse (POP) is a highly prevalent condition worldwide. It is estimated to affect approximately 50% of parous women1. The lifetime risk for surgery for POP or urinary incontinence has in recent times been quoted as 11%2. New data has however shown that this is an underestimation of current trends and that the lifetime risk is currently 20% at the age of 80 years3. Although South African data are lacking, local pelvic floor surgeons are seeing an increasing number of women presenting with and requiring surgical correction of their prolapse.
The last decade has seen an increase in the use of mesh-based products with many surgeons electing to use a mesh kit device. The expanding use of mesh kits is due to ease of use, increased surgeon training and the perception that traditional native tissue vaginal pelvic floor repairs for POP have a poor long term outcome. Aggressive marketing and industry sponsored training has also played a role in the adoption of these new techniques.
In July 2011 the FDA released a document (FDA Safety Communication: UPDATE on Serious Complications Associated with Transvaginal Placement of Surgical Mesh for Pelvic Organ Prolapse; July 12, 2011) warning surgeons to be selective when using mesh for POP repairs4. The FDA concluded that “serious complications associated with surgical mesh for transvaginal repair of POP are not rare” and that “it is not clear that transvaginal POP repair with mesh is more effective than traditional non-mesh repair”. One of the recommendations is to “choose mesh only after weighing the risks and benefits of surgery with mesh versus all surgical and non-surgical alternatives”. It is significant to note that this warning did not include the use of abdominal mesh for POP surgery (e.g. sacrocolpopexy), nor the use of full-length midurethral mesh for the treatment of stress urinary incontinence (e.g. TVT/TOT).
In January 2012, the FDA introduced to industry mandatory post market surveillance of all mesh implanted in the vagina – so called “522 studies”, together with the gathering of comparative data between mesh kits and conventional surgery. Since then, some 88 post market study orders have been issued to 33 manufacturers of vaginal mesh kits. Given the financial burden of performing such studies, some manufacturers have withdrawn wholly (Johnson and Johnson) or partially (Boston Scientific, CR Bard) from the market and anecdotally the overall use of vaginally implanted mesh in the USA has fallen by 40 – 60% since the FDA update announcement of July 2011.
SAUGA developed this document to serve as a position statement on the use of mesh and mesh-based kits in vaginal POP surgery.
Click here to read more
Staying out of trouble: Urinary tract complications in pelvic surgery
Dr Lisa Kaestner, Urologist Division of Urology, Groote Schuur Hospital, UCTUrinary tract complications in pelvic surgery are not uncommon. Many of these complications can be avoided by an excellent knowledge of surgical anatomy and insight into possible complex pathologies requiring the involvement of a multidisciplinary team.
This is a review a few basic principles to avoid and manage urological injuries.
General principles
Numerous studies have reported a decrease in complications with experience in laparoscopic pelvic surgery. Awareness of this learning curve should allow prudent case selection for laparoscopic procedures based on complexity of the clinical problem.
Click here to read more
Please note that the programme is subject to change.
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Day 1 - Thursday, 10 August 2017 - Pelvic Floor Ultrasonography Workshop |
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07:30 |
Registration and arrival tea / coffee |
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08:45 |
Welcome Address |
Dr S Ramphal |
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09:00 |
Presentation: Pelvic floor ultrasonography - anatomy overview |
Prof G Santoro |
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10:00 |
Tea and coffee break |
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10:15 |
Presentation: Pelvic floor ultrasonography - technique overview |
Prof G Santoro |
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11:00 |
BK equipment 101: Hands-on equipment orientation and handling |
Prof G Santoro |
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12:00 |
Lunch break |
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12:30 |
Live cases: Full three compartment scanning following general steps and protocols 3D scanning of posterior compartment including assessment of sphincter damage Full three compartment scanning following and identification and assessment of enterocele |
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15:00 |
Tea and coffee break |
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15:15 |
Presentation: Case reviews - How to assess and what to do with the information obtained |
Prof G Santoro |
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Day 2 - Friday, 11 August 2017 |
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Live Surgery Cases: Laparoscopic sacrocolpopexy Laparoscopic hysterectomy with pelvic floor repair Mid-urethral tapes Laparoscopic neovagina Bulking agents |
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Day 3 - Saturday, 10 August 2017 |
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Lectures by National and International speakers covering the following topics: Role of laparoscopy with prolapse Is there any place for vaginal mesh? Apical prolapse - bottom up or top down Surgical options for posterior compartment defects Choices of surgery for stress urinary incontinence in 2017 Failed mid-urethral slings. Management options Role of peri-urethral bulking agents Overactive bladder Pelvic floor assessment and rehabilitation Laparoscopic urogenital fistula repair |
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Thank you to Professor Cronje for the stunning images |
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| SAUGA NEWSLETTER | JULY 2017 |