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More than half of all women experience some type of pelvic floor problem during their lifetime. Pelvic floor disorders like urinary incontinence or pelvic organ prolapse can have a dramatic effect on a woman’s quality of life causing both physical and emotional discomfort, and interfering with daily and social activities.
Many women are surprised to learn that incontinence and prolapse are both common and treatable. There are a variety of new and effective therapies available. Urogynecology Associates provides comprehensive evaluation and treatment for female pelvic floor disorders including pelvic organ prolapse, urinary incontinence, postpartum vaginal/sphincter trauma and overactive bladder symptoms
At Urogynecology Associates, we approach each patient with the goal of providing an accurate diagnosis and treatment options that meet the specific needs of the individual.
Our offices are conveniently located in Delaware, Chester and Montgomery Counties, just west of the city of Philadelphia. Our physicians maintain staff privileges at each of the Main Line Health Hospitals, including Riddle Hospital, Lankenau Medical Center and Paoli Hospital.
Dr Toglia has been named a Top Doctor in Philadelphia Magazine
for the sixth year in a row!
 2005 2006 2008 2009 2010 2011
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Interstim Therapy approved for the treatment of Bowel Incontinence
Questions About Vaginal Mesh? On July 13, 2011, the FDA issued a safety communication update, intending to inform patients and healthcare providers that “serious complications associated with surgical mesh for transvaginal repair of pelvic organ prolapse are not rare”.
The FDA communication was based upon over 2, 874 reports of complications associated with surgical mesh devices used in the repair of pelvic organ prolapse and stress urinary incontinence. It should be noted that these reports represent less than 1 % of the total number cases performed for these problems in the three year period surveyed. Concerns included the vaginal erosion of mesh, chronic pain, pain with sexual intercourse, and urinary problems.
The FDA was concerned regarding the lack of substantial scientific evidence supporting the use of vaginal mesh kits compared to traditional surgical repairs options. It should be noted that one of the gold standard procedures for prolapse surgery – the abdominal sacral colpopexy – which utilizes a similar type mesh material, but placed through an abdominal incision and with different attachment points, was not considered controversial. One focus of the FDA report was to ensure that physicians were doing an adequate job of counseling patients regarding surgical options and risks regarding all procedures for prolapse and incontinence.
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The development of vaginal mesh kits for surgical management of prolapse came about as an extension of other highly successful procedures involving mesh, including the Sacral Colpopexy (abdominal placement of mesh), the TVT sling (mesh sling for treatment of SUI), as well as the use of mesh in general surgery for the treatment of abdominal mesh hernias. At the present time, the use of mesh to treat stress urinary incontinence by placing a thin band of mesh beneath the mid-urethra and exiting either behind the pubic bone (eg retropubic mid urethral sling) or through the thigh (eg obturator sling) are considered the standard of care and research over the pass two decades have shown that they are both safe and effective. Likewise, as mentioned above, the use of a polypropylene mesh attached to the vaginal walls through an abdominal incision and attached to the sacrum (just above the tailbone), during a procedure known as a Sacral Colpopexy has been an accepted treatment for pelvic organ prolapse for over 50 years.
There has been, understandably, a significant amount of confusion and misunderstanding about pelvic floor mesh in general since the FDA report. It is important for patients to understand the differences between procedures involving mesh, especially since many of the gold standard operations include the use of extensively tested mesh as we have just illustrated. In our opinion, much of the concern on this topic involves proper patient selection, appropriate training of surgeons, as well as the specific anchor points for the mesh procedures, rather than the material itself. There is no question that additional research needs to be completed to fully understand the value and risks of newer surgical procedures.
Urogynecology Associates of Philadelphia has extensive experience with the use of mesh in the treatment of pelvic floor disorders such as prolapse and urinary incontinence, including over 500 vaginal mesh kit procedures. Our group has performed over 2,000 minimally invasive sling procedures for stress urinary incontinence. In general, we support the use of mid urethral sling mesh (eg TVT sling) as the current gold standard in the treatment of SUI, and the use of mesh for abdominal sacral colpopexy as a gold standard for the treatment of advanced stages of pelvic organ prolapse. We continue to support the selective use of transvaginal mesh for the repair of pelvic organ prolapse in cases in which its use is felt to be beneficial and appropriate, and when we feel that the patient adequate understands all of their options, and is comfortable with our largely positive experience with these procedures. We agree with the recommendations of the FDA and several medical societies that surgeons who perform these procedures should have extensive experience and knowledge in the treatment of these conditions and the use of mesh, choose patients appropriately, and advise patients when they are not a good candidate for any specific operation.
Urogynecology Associates maintains a large patient database of women in whom we have performed these procedures, and we are continually reviewing our results. Our physicians have been involved in clinical research in this area, and, in general, our data suggests a largely positive experience, and high patient satisfaction. We have been diligent to report any unusual problems directly to the FDA over the past decade.
Finally, our physicians have extensive experience in the evaluation and management of women who have experienced complications from transvaginal mesh procedures, including the surgical revision or removal of such devices. We remain a referral practice for such cases for the tri-state area. If you are a such a women, we would encourage you to schedule an appointment with one of our physicians for a consultation regarding your treatment options.
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