SALT LAKE CITY — Surgical mesh is likely the best product available for repair of vaginal prolapse, despite recent FDA warnings, according to local doctors.
The recent warnings have prompted manufacturers to further study the efficacy of the mesh, and doctors are also asked to be more vigilant in discussing the risks with patients, said Dr. Orrenzo Snyder, a urologist at Intermountain Healthcare's Riverton Hospital. Erosion and extrusion risks, he said, are still very low and the product's performance rates remain high.
Use of the mesh, while a popular topic on its own, was not discussed in many of the calls to Intermountain docs during Saturday's Deseret News/Intermountain Healthcare Health Hotline. However, Snyder, and Dr. Christopher Hutchison, an OB-GYN at Riverton Hospital, want the public to know mesh is still safely being used to fix urinary incontinence.
Of more than 50 callers Saturday, the majority of questions pertained to bladder spasms, a constant urge to pee that is caused by a variety of things, including diet and genetics. Medications are used to treat the overactive bladder, but side effects that come from using those drugs are often annoying, Hutchison said.
"Imagine walking around always thinking you need a drink," he said. "Dry mouth then augments incontinence because some do drink a lot more, therefore needing to urinate a lot more."
Many patients with overactive bladder symptoms were referred to Snyder's office for further evaluation, or urodynamics, a diagnostic study of pressure in the bladder. He said the procedure can help doctors to know how to help patients best.
The average age of callers Saturday was around 65, with many callers interested in helping their aging mothers gain control of urinary incontinence. Some had already endured various surgeries and the doctors stressed the importance of remedying urgency issues before trying to fix anything else, as it can make things worse to tackle it all at once.
While the calls weren't representative, Hutchison said one in three women, young and old, have had some issue with incontinence in their lives. He added that it doesn't usually matter how many kids a woman has had, as jobs that require repeated heavy lifting can also lead to increased bladder leakage.
Bladder training, in which patients are instructed to urinate on a timed schedule, was discussed with a few callers to help incontinent people teach their bladder how to relax and expand slowly, without sporadic spasm.
Snyder said he sometimes instructs patients to "stand up, sit down and pee twice," which he said will help to fully empty the bladder.
"It's another way to train the bladder without pushing or putting pressure on it," he said. For more information, he suggested the American Congress of Obstetricians and Gynecologists as a resource.
Doctors also discussed the importance of healthy estrogen levels in women dealing with vaginal issues, including urinary incontinence. Using vaginal estrogen cream, Hutchison said, "is not hormone replacement therapy." A lot of incontinence issues creep up when estrogen levels start to drop in women, because vaginal mucosa thins out without estrogen.
"Estrogen plays such a vital role in the vaginal health of a woman," he said.
In all, calls kept the hotline doctors busy Saturday.
The health hotline is offered to readers through a partnership between Intermountain Healthcare and the Deseret News. It covers a different health topic the second Saturday of each month.