Urologist and surgeon Dr. Shlomo Raz is considered by many to be the most experienced mesh removal doctor in the world. Women fly to the University of California Los Angeles (UCLA) Department of Urology to see Dr. Raz because of his expertise in dealing with pelvic mesh complication.
Dr. Raz has been exposed to all of the issues associated with pelvic mesh including mesh erosion, chronic infection, chronic pain, shrinkage, foreign body response, urinary tract infections and folding, entrapping nerves. Dr. Raz has written about his experience with the complications in numerous published studies. His book, Female Urology, 1980, followed by the second edition in 1996 is considered a bible for training. Dr. Raz is so well informed in the topic that those who train under him consider their experience with him to grant them bragging rights.
While Dr. Raz had used polypropylene implants at one time, he has since ceased to do so because of his observations years after insertion. These complications arise ten, even twelve years after the pelvic mesh insertion for either incontinence or prolapse. Because of this, Dr. Raz confirms mesh is not inert and develops a life of it’s own after it is permanently implanted.
To Mesh or Not to Mesh is an ongoing debate within the female urology community. In a 29-minute webcast at the American Urological Association last year, Dr Raz debated the issue with Dr. Paulo Palma, a professor of Urology from Brazil. Dr. Palma was there to promote mesh for stress urinary incontinence (SUI) use which he calls minimally-invasive and the “Gold Standard.”
Dr. Palma stated that with a standard suture repair, known as a Burch Procedure, there is a 49% cure rate compared to a 66% cure rate for incontinence with a sling. But whatever the “sling” or “tape” or polypropylene mesh, Dr. Raz explains in the webcast that he is seeing many complication years later which include erosion, a high number of urinary tract infections (UTIs) and pelvic pain.
It is also important to note that Dr. Palmas definition of a successful surgery may not be relevant. For years “mesh in place” was considered a successful surgery regardless of the level of pain experienced by the woman.
No long-term studies, even on dogs, were ever conducted on the use of pelvic mesh polypropylene implants. We are only now we are seeing the real life clinical trials.
As a result of what he is seeing in these trials, Dr. Raz has abandoned the use of synthetic mesh.
It is perplexing how hundreds of thousands of mesh injuries could merit the “Gold Standard” label. Some doctors still insist that this standard is viable.
AUGS, the American Urogynecologic Society, stands by mesh as a mid-urethral sling as a treatment option for patients. Interestingly, while the AUGS calls it the most-studied procedure for SUI in medical literature, the Food and Drug Administration did not required a single clinical trial before slings were approved for sale.
Dr. Raz estimates that three million slings have been inserted. Last year’s publication of a five-year longitudinal follow-up study of slings finds their effectiveness decreased over time as did quality of life issues.
In the last five years, Dr. Raz says he has removed about 1,300 mesh implants due to complications. What occurs inside the body once the mesh or sling is implanted? This is a question that should have been posed before polypropylene pelvic mesh implants were put permanently in the body.
To answer the question, UCLA started a biofilm project. Beginning with 1,300 patients, scientists removed slings from the area of the urethra where they were placed to treat incontinence. Twenty percent of the patients exhibited systemic symptoms such as skin rashes, hair loss, sinus problems, and lung issues.
The theory is that unavoidable contamination with vaginal bacteria, considered a clean-contaminated field, during placement may result in bacterial biofilms on the mesh. The chronic bacterial colonies and their biofilm protective coating, create systemic effects on the woman.
Today Dr. Raz does repairs to pelvic organ prolapse (POP) and stress urinary incontinence (SUI) using a fascial sling taken from the ileo-tibial band in the leg. Five to ten cm of tissue is harvested from the patient. Then, using a fascial stripper, he creates a band of tissue that the body will fully integrate with no foreign body reaction.
Dr. Raz calls this an excellent quality sling with minimal pain and a quick recovery, which may be why the waiting list to see this doctor is usually about six months long. Many women feel it’s worth the wait.