Rockledge, Florida

Marja Sprock, M.D., FACOG, FPMRS Board Certified
Fellowship Trained Urogynecologist

Now Accepting New Patients

info@CFUroGyn.com      Phone:  321-806-3929

Recently Published

new  New Treatments for Vaginal Atrophy

new  The Healthy Weight Lifestyle Formula

new  Small Battery Can Fix Bowel Control Issues

new  Laser and the Vagina

new  Fecal Incontinence  - More Common Than You Think!

new  Overactive Bladder

new  Painful Bladder Syndrome / Interstitial Cystitis

new  Stress Urinary Incontinence

new  The Thrill is Gone

new  Chronic Constipation

Laser Treatment for Vaginal Atrophy

Have You Had Your Pap Smear?

Resources for Pelvic Floor Disorders

The Uterine Fibroid Dilemma

Are You Leaking ?

New Non-Surgical Laser Solution for Stress Urinary Incontinence

New Treatment Option for Stress Urinary Incontinence

Non-hormonal Vaginal Atrophy Treatment -- Non-painful Sex Without Estrogen

In-Office Painless Laser Vaginal Tightening

Central Florida UroGynecology Announces LASER 4D Aesthetics

Accidental Bowel Loss - A Socially Hidden Problem

Nerve Stimulation to Treat Urinary and Fecal Problems

Is UTI a Major Health Problem?

It Appeared to be an Overactive Bladder

Pessary Treatment of Prolapse

Overactive Bladder Evaluation Chart

Accidental Bowel Loss or Fecal Incontinence

Overactive Bladder Guidelines

Vaginoplasty and the “Designer Vagina”

Surgical Treatment of Stress Urinary Incontinence

Recurrent UTI - Urinary Tract Infection

Pads are "Out of Style"

Stool or Bowel Incontinence

Pain with Sex

Nightime Urination

A Tighter Vagina - the Answer to Happiness

Do not Let Urine Loss Color the Golden Years

Office Injection Procedure for Urinary Incontinence

Read a Magazine and Regain Urinary Continence

Position Statement on Mesh Midurethral Slings

Botox Covered by Insurance

Walk to Guard Against Disease!

Estrogen Treatment Possible Side-Effects Often Overstated -- Consider the Benefits!

What the doctor does not tell you…

Tips from Dr. Sprock
September 2013

Health and Feeling Good About Yourself

I have to Go All the Time

Treatments for Fecal Incontinence

Third Generation i-Lipo Xcell now available!  FIRST IN U.S.A.

Central Florida UroGynecology Opens Its New Facility on Eyster in Rockledge

Tips from Dr. Sprock
    
 March 19     March 10

But I don't have to go ...

Pelvic floor muscle training and the In Tone® device

Jessica Alba had i-Lipo, Would you?

Take Action in the New Year !!

InTone Home Device to Treat Urinary Incontinence

Regenlite Skin Tightening and Collagen Stimulation

New Options for Incontinence

Sexy Meshes ???

Control Incontinence.  Enjoy Being a Senior!

A Happy Patient Testimonial - Swimming Again After Bladder Procedure  <external>

Getting Rid of Adult Diapers

Nocturia, Nighttime Voiding

Dr. Sprock Connects with her Patients

Inches Off Where You Want Them Off - I-Lipo® Introduction

Another Incontinence Success Story

Space Coast Daily:  Dr. Sprock Does I-Lipo  <external>


Previously Published by Category

URINARY ISSUES

FECAL STOOL ISSUES

SEXUAL HELP

COSMETIC GYNECOLOGY

I-LIPO

PROLAPSE

OVERVIEW


Technical & Educational Info


All Published Articles

 

The FDA, Vaginal Prolapse Repairs and Implications
By Marja Sprock, M.D.

On July 13th, the FDA issued an updated warning against the use of vaginally implanted meshes. This was based on the perceived high number of reported complications for this biomedical device used to treat severe and often recurrent vaginal prolapse. The repair without the use of an artificial material, be it polypropylene or derived from animal sources, does not get reported, since it does not involve FDA regulated material.

The pelvic prolapse surgeon network has drafted a letter to the FDA that I cosigned, to put some of the accusations against mesh material used in the vagina in perspective.

The goal of the letter, which has already received over 400 pelvic floor surgeon signatures is to express our opinions and concerns to the FDA, since the July update fails to convey an accurate reflection of the vaginally placed mesh for prolapse repair and is not consistent with the current literature and experience. In broader perspective; every prolapse option involves risks and benefits.

In actuality, a lot of people, including other physicians start laughing when I tell them: "I fix vaginas"; reality is, it is an art and you need to know what you are doing. A lot of weight is put on a vagina, it has to withstand a lot of forces, and we do not like it too wide or too small, not too deep and not too superficial and keep on going. Once your entire vagina or parts of it start hanging down and put pressure on your back or make it difficult to empty your bladder or rectum, or you are up the whole night going to the bathroom, you'd like some relief. Pessaries, small shelves to hold up a bladder or small bowel are great for some people, however they create discharge, are less than romantic to take out right before intercourse and sometimes do not even hold the large prolapsed vagina anymore.

Vaginal repair of prolapse without a mesh is definitely an option, however for the descent of vaginal tissue to the opening of the vagina or through the opening, not very realistic. Support is severely defective and the past has shown us, a lot of these "native tissue repairs", or in other words use your existent defective tissue repairs, do not work, last or make sex impossible or painful or cause pelvic pain. The same problems you could get with mesh repairs. Again vaginal prolapse repair is an art, it is for the specialist.

Laparoscopic, robotic or abdominal sacrocolpopexy is our "gold standard"  for vaginal prolapse repair. It uses the same mesh material; however the mesh is introduced through the abdomen and not the vagina. Research shows this approach has the lowest failure rate, however there are also mesh erosion problems (mesh showing itself without vaginal tissue covering) and the bowel could get stuck to the mesh, often requiring another invasive surgery. Also for a lot of women this approach is not an option, since the surgery is more involved and takes longer. If you are a healthy 55 year old with your bladder protruding through your vagina, it is probably a great surgery for you, but not if you are the same age, have severe diabetes mellitus and had a quadruple bypass. However you may still not desire a pessary, but want your vagina surgically fixed.  A vaginally placed mesh may be the best option for you,-let us not prevent this from happening. Another option, the only prolapse surgery that I refuse to do, is to close off the vagina. The published rate of complications for the colpocleisis, is close to 33% and I refuse to take away/close a vagina, if I can fix the problem in the same amount of time with a mesh and much lower rate of complications.

The vaginal prolapse surgeon consortium is fighting for women with the data from the literature to support us, that there is a place for the vaginally inserted mesh. Other repairs of the severely descended vagina all come with their potential problems also, there is no free lunch.

Pelvic Organ Prolapse Repairs and Their Potential Complications

Women need their options, severely prolapsed vaginas interfere with quality of life, do not take away a good option to repair a vagina for the right woman in the right surgeons hands. A high rate of satisfaction is noted for patients undergoing vaginally placed mesh repairs, in the hands of well-trained pelvic floor surgeons, as quoted from the evidence based response from Pelvic Surgeons to the FDA Safety Communication.

Yesterday I saw Ruth, a 78 year old active lady in the clinic, 6 months after vaginal insertion of a mesh to fix her bladder and top of vagina prolapse through her vaginal opening. Ruth is doing great and has a normal well-functioning and supported vagina. When asked if she read some of the articles that had come out regarding the FDA mesh warning, she said sure, "means little to me. You told me it was no 100% guarantee and told me about possible problems and I accepted that. To interview some people with problems, means little to me, it is sad, but will happen with any surgery, I am great now."

My next patient Mary, another 78 year old, used to have her vagina hanging out for 1.5 inches and came for her 2 year checkup. Mary wrote me a little testimonial: "This surgery has improved my quality of life and all my check-ups have been excellent. This prolapse caused a lot of stress on me and my recovery was quick and easy. Thanks, Mary R”.

Not every vaginal prolapse needs repair, not every prolapse repair needs mesh and not every mesh repair can be done laparoscopically or robotically. The experienced vaginal surgeons are speaking up for women to keep the option of repairing a severely prolapsed vagina with vaginally placed mesh open. There are possible complications with any surgery, any surgeon claiming there are none, has either not done enough of them, is never in the operating room or is untruthful.

Severely prolapsed vaginas are debilitating and interfere with the quality of life of many women, a vaginally placed mesh in the right surgeon's hands  could be the best choice for some of us, let us not give up this option. Remember there is no free lunch; any surgery has its risks and benefits.

Marja Sprock, MD, FACOG, is fellowship trained in urogynecology by David Richardson at Henry Ford Hospital in Detroit, has more than 10 years of experience in pelvic floor prolapse repairs and is up-to-date on new and minimally invasive techniques.

Please call for an appointment at 321-806-3929, send us a note or visit us online at www.CFUroGyn.com. 


Central Florida Urogynecology

101 Eyster Boulevard, Rockledge, FL 32955

Phone 321-806-3929

Copyright 2009-2016 Central Florida Urogynecology.  All Rights Reserved.

 

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updated:  January 11, 2016