Neil Osterweil

May 29, 2014

ORLANDO, Florida — Like it or not, patients are getting much of their information about vaginal mesh from YouTube or from television, new research shows.

Unfortunately, this kind of research offers patients "a lack of both content and neutrality related to the use of mesh for pelvic organ prolapse repair," said Areeba Sadiq, BS, a senior medical student at the New York University School of Medicine in New York City.

She and her colleagues reviewed videos about mesh surgery for pelvic organ prolapse posted on YouTube. They found that more than two-thirds of the videos were posted by legal firms.

Presumably, this is because they want to cash in on the 2011 safety communication issued by the US Food and Drug Administration (FDA) about complications associated with vaginal mesh for this indication, Sadiq explained.

She presented results from the study here at the American Urological Association 2014 Annual Scientific Meeting.

Another presentation, by Christopher Tenggardjaja, MD, from the Glick Urologic and Kidney Institute at the Cleveland Clinic, and colleagues revealed that most patients get their information about mesh from television.

And the information they get is not always accurate. Although nearly two-thirds of patients surveyed had heard of the FDA advisory, more than 50% thought that there was a mesh recall when there was not, he said.

A Caution, Not a Recall

The safety communication advised that the FDA had received reports of complications associated with surgical mesh placed transvaginally to treat prolapse or stress incontinence.

"The most frequent complications included erosion through the vagina, infection, pain, urinary problems, and recurrence of the prolapse and/or incontinence. In some cases, erosion of the mesh and scarring of the vagina led to discomfort and pain, including pain during sexual intercourse," the communication states.

It adds that it is not clear whether treating pelvic organ prolapse with mesh is more effective than traditional repair methods, and that the presence of mesh could expose patients to a greater risk for complications than other methods. However, the FDA did not recall mesh.

It Must Be True, It's on the Internet

Sadiq and her colleagues evaluated information available on YouTube. Research has shown that 72% of Internet users go online for health information, and that 32% of social media users rely on YouTube for making healthcare-related decisions.

The research team searched YouTube for the term "pelvic organ prolapse repair with mesh." They limited their analysis to the first 100 videos identified.

They excluded the 51 videos that were not in English, had no audio, were longer than 10 minutes, or were part of a series.

For each of the 49 remaining videos, they assessed type (medical or legal), length, time posted online, number of views per month, shares on social media, comments, and subscriptions.

Each video was watched by 2 viewers and scored with a predetermined formula, which took into account the presence or absence of an introduction to prolapse repair, information about its management, an explanation of the FDA communication, and whether the information presented was balanced.

Overall, 69% of the videos were considered to have a legal orientation, 24% were of medical origin, and 7% were neither.

Legal videos were significantly more like to contain an explanation of the FDA communication, whereas medical videos were more likely to provide balanced information about the management of pelvic organ prolapse and an introduction to prolapse repair.

In general, medical videos tended to be longer than legal videos, to spend more months online, and to have more views per month.

"There is tremendous potential to use YouTube as a source for patient education and awareness," Sadiq explained. Healthcare professionals, members of professional societies, patient advocates, and members of industry should take advantage of this, she added.

TV Nation

Dr. Tenggardjaja and colleagues conducted their survey to understand the decline in mesh use after the FDA safety communication, both nationally and at the Cleveland Clinic.

Specifically, they wanted to see whether patients believed that there was a mesh recall, whether they were aware of the FDA communication, and what influenced their attitudes.

They asked new patients at a single-specialty urology clinic who complained of incontinence or pelvic organ prolapse to complete a 25-question survey.

Of the 214 respondents, 43 reported having prolapse, 157 reported incontinence, and 14 reported both.

Patients were asked whether they personally knew someone who had undergone surgery with mesh for either of the conditions. Of those who did, 41% said the person was happy with the results, 49% said the person was not, and 10% were not sure.

As the primary source of medical information, 59% of respondents cited television, 14% cited the Internet, 13% cited their physician, 9% cited word of mouth, 4% cited the radio, 2% cited mail, and 3% cited other.

Overall, 61.8% of respondents were aware of the FDA safety communication, and 51.5% believed that there was recall.

Patients who listed TV as their source of information were 5.60 times more likely than others to be aware of the communication (= .0002), but were also 2.42 times more likely than others to believe that there was recall (P = .03).

This "leaves us with plenty of room as physicians to continue to educate these patients," Dr. Tenggardjaja said. Physicians in general, and urologists in particular, need to be at the forefront of patient education and dissemination of information, he added.

Patient misperceptions about the benefits and risks of vaginal mesh are very common, said Thomas Griebling, MD, MPH, professor and vice chair of urology at the University of Kansas Medical Center in Kansas City, who was not involved in either study.

"I see a lot of people who have had mesh put in by another surgeon and may or may not be having symptoms," he told Medscape Medical News. "They come in with a variety of questions and concerns, so we go through this issue in great detail, especially the difference between the mesh used for stress incontinence as a sling-type procedure, and that used for prolapse, which is very different."

In addition, "I see a sizable number of patients who really are not having symptoms but are concerned because they have had previous mesh surgery," he explained. "I counsel them about what to watch for, what could be concerning symptoms that they may develop in the future, and reassure them that if they're doing well, they may continue to do well," he said.

Both studies were internally funded. Ms. Sadiq, Dr. Tenggardjaja, and Dr. Griebling have disclosed no relevant financial relationships.

American Urological Association (AUA) 2014 Annual Scientific Meeting: Abstracts PD33-08 (Tenggardjaja) and 29-09 (Sadiq). Presented May 20, 2014.

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