Laird Harrison

May 20, 2013

SAN DIEGO, California — Advertising by personal injury law firms is reaching, and worrying, women who might be candidates for transvaginal synthetic mesh, a new study shows.

Most women surveyed at 2 urology and urogynecology clinics were aware of the mesh, but their information had come predominantly from advertisements by personal injury law firms, Michelle Koski, MD, from the Medical University of South Carolina in Charleston, told reporters attending a news conference.

"It's a vulnerable population and they are getting all of this misinformation," she said.

Dr. Koski presented a survey of women's attitudes about mesh here at the American Urological Association 2013 Annual Scientific Meeting.

The researchers found that more than 90% of the results of a Google search were advertising for lawsuits.

To measure the impact of these ads, they surveyed female urology and urogynecology patients at Louisiana State University and the Medical University of South Carolina.

Of the 99 women who completed the questionnaire, two thirds said they had heard of the mesh. Of these, most said they learned about it from an advertisement for legal action on television, radio, or online.

Still, three quarters of the women were open to considering the mesh, particularly if counseled by a physician, a finding the researchers said they found "encouraging."

Table. Responses to Survey About Transvaginal Mesh

Responses Percentage (n = 99)
First heard about mesh from legal advertising 57.6
First heard about mesh from medical professional 9.1
Opinion of mesh most influenced by advertising 33.3
Opinion of mesh most influenced by medical professional 22.7
Would consider mesh for prolapse 75.8


Most patients could not distinguish between mesh used to treat prolapse and mesh or sling used to treat incontinence, Dr. Koski reported.

Experts are divided on the merits of both devices, she pointed out. "There are doctors who are advocates and some who are opponents."

The mesh has been controversial. In October 2008, the US Food and Drug Administration (FDA) issued a safety communication warning of potential problems.

"This is to alert you to complications associated with transvaginal placement of surgical mesh to treat pelvic organ prolapse and stress urinary incontinence," the agency wrote. "Although rare, these complications can have serious consequences."

In July 2011, the FDA updated the notice, saying that "serious complications associated with surgical mesh for transvaginal repair of pelvic organ prolapse are not rare," and that the FDA "continues to evaluate the effects of using surgical mesh to repair stress urinary incontinence and will communicate these findings at a later date."

Lawyers have been filing suit against companies that make the mesh and aggressively advertising their services to patients. Some of the ads include false or misleading information, Dr. Koski said.

In a review of the literature, FDA researchers concluded that "transvaginally placed mesh in pelvic organ prolapse repair does not conclusively improve clinical outcomes over traditional nonmesh repair."

Dr. Koski said she thinks the mesh for prolapse has "positive aspects for certain patients."

She spoke more favorably about slings used to treat incontinence. "The transurethral sling has always been lauded for incontinence, but it's getting dragged into this mess by people who don't have any medical knowledge," Dr. Koski said.

Physicians should carefully explain the pros and cons of the devices to their patients, she advised. "Personally, I take a lot of extra time to talk to patients about the lawsuits and ads," she said. "I give them a copy of the FDA warning and talk to them about it."

News conference moderator Tomas Griebling, MD, from the University of Kansas in Kansas City, said the controversy has reached his practice as well. "I've had letters from attorneys asking what product was used," he said. "Often mesh was not used. It might have been autologous tissue."

The study received no outside funding. Dr. Koski and Dr. Griebling have disclosed no relevant financial relationships.

American Urological Association (AUA) 2013 Annual Scientific Meeting: Abstract 2150. Presented May 8, 2013.


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