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![]() Message from the President:Dear Colleagues |
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A New Urodynamics unit was opened recently at the Olivis Barnad Memorial
Hospital |
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SAUGA Position Statement on Mesh | |||||||||||||||||||||||||||||||||||||||||||||
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 | |||||||||||||||||||||||||||||||||||||||||||||
Dr Lisa Kaestner | |||||||||||||||||||||||||||||||||||||||||||||
Staying out of trouble: Urinary tract complications in pelvic surgeryDr 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 | |||||||||||||||||||||||||||||||||||||||||||||
SAUGA CONFERENCE | |||||||||||||||||||||||||||||||||||||||||||||
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Congress Scientific Programme | |||||||||||||||||||||||||||||||||||||||||||||
Please note that the programme is subject to change.
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