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    Removal of Faulty Mesh for Incontinence

    Experts say there's still no clear-cut answer as to whether or not to have surgery


    A big caveat, however, is that pain had been the sole issue for all of the women before surgery.

    The second study, by researchers at the University of California, Los Angeles, had less-positive results. It surveyed 214 women about three years after they'd had their mesh implants removed; these patients had opted for surgery due to a range of symptoms, not only pain.

    Post-surgery, many women continued to have problems, the study found. Although two-thirds of the women said they had no pain or only mild symptoms, the rest had moderate to severe pain. Twenty-eight percent said they had urine leakage at least once a day, and half had pain during sex, according to the study.

    The study, however, had its own limits. The researchers sent surveys to nearly 700 women who'd had surgery at their center, but only one-third responded. It's possible that women who'd continued to have problems were more likely to respond.

    So what should women do? Zimmern said that despite the good results in his study, women should not rush into surgery.

    "We can only say that in this subset of patients, the outcomes were better than we expected," Zimmern said.

    It can't be assumed that the results would extend to women more generally. For one, Zimmern explained, pain was the only reason for device removal, and it's not clear that the outcomes would be the same for women who had pain and other symptoms.

    Plus, Zimmern said, the study included no patients who'd gone with nonsurgical options -- like physical therapy for the pelvic floor muscles, or "trigger point" injections with medications that ease pain and inflammation.

    "This study might have included a select group of women," Zimmern said.

    The issue is complicated, agreed Dr. Tomas Griebling, a professor of urology at the University of Kansas Medical Center in Kansas City.

    "I think most [doctors] would advise patients with no adverse signs or symptoms that they do not need to undergo surgical removal of mesh implants," said Griebling, who was scheduled to moderate a discussion of the studies at the meeting.

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