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THE BEST TREATMENT a stretched dock line holding a boat shown.” Dr. Sepulveda said. “There is a
Urogynecologist Jaime Sepulveda a float, it will easily sink with weight. A possibility that mesh midurethral slings
M.D. has successfully treated more than miduretrhal sling replaces the stretched may no longer be produced because of
2,000 women suffering from stress uri- or broken supporting structure of the a type of litigation that has a disconnect
nary incontinence using a device known urethra, the tube valve that keeps urine from the current medical and scientific
as the mesh midurethral sling. The sling in the bladder.” evidence.”
is placed using local anesthesia during a As recently as the 1980s, the Synthetic midurethral slings are the
25-minute outpatient procedure. primary treatment for stress urinary current clinical standard for the treat-
According to Dr. Sepulveda, the incontinence was placing sutures at the ment of urinary stress incontinence. The
American Urogynecologic Society and junction of the urethra and bladder, a use of midurethral polypropylene im-
nine other worldwide medical organi- very sensitive area. This required general plant is supported by over 2000 medi-
zations concerned with female pelvic anesthesia, an abdominal incision and a cal studies and the prestigious Cochrane
medicine, the mesh midurethral sling is lengthy recovery period. Not only was Scientific Collaboration (cochrane.
the safest, most effective and durable there a risk of complications from this org). As with other implants used in
treatment for stress urinary inconti- major surgery, in some cases the sutures the human body to replace defective
nence. caused obstructions, difficult urination tissue or a broken structure a risk of
“Cure is more important than and contributed to bladder overactivity. revision exist with synthetic midurethral
improvement” explained Dr. Sepulve- Unfortunately, new problem of urinary slings. Revision is the professional term
da. “The highest level of medical-sci- frequency, urgency and incomplete blad- used to describe a reintervention for a
entific evidence demonstrates that in der emptying were created complicating surgical procedure or an implant. It is a
the treatment of clinically confirmed the treatment of the initial issue. risk that exists even if your own tissue is
urinary stress incontinence conservative The solution was straight out of used. When studied at 10 years, the risk
treatments such as pelvic floor exercises “Back to the Future.” Polypropylene of requiring a midurethral sling revised
and behavior modification will only im- sutures had been widely used in is as low as 2%-3%. For comparison,
prove the condition, whereas the mesh operating rooms for 50 years. A finely joint replacements have a 6 % to 12%
midurethral sling will cure it. After more knitted mesh sling was invented using rate of revision and breast implants are
than 2,000 documented studies, the the suture material and found to be revised at rates over 25%.
science is crystal clear on the efficacy, well tolerated by patients, safe and Patients suffering from stress urinary
durability and safety of midurethral syn- durable. Studies and more studies were incontinence should prepare ahead of
thetic slings for the treatment of urinary conducted, all finding the mesh midure- their consultation in order to have a
stress incontinence.” thral slings to be the safest and most relevant, evidence based conversation
In fact, there have been more stud- effective treatment option. Studies were about their surgical options. Profes-
ies completed on the mesh midurethral undertaken to unprecedented quality, sional societies such as the sites of the
sling than almost any other medical scrutiny and follow up. The most recent American Urogynecologic Society, The
procedure in history. And in 2016, the ones evaluate the experience seventeen American Urological Association, The
American Urogynecologic Society is- years after the initial surgery. International Urogynecologic Asso-
sued a statement touting the procedure ciation and the Cochrane library are
as the safest and most effective treat- SHOW ME THE FACTS reliable sources conversation. “Your
ment for stress urinary incontinence. In the past, American consum- surgeon’s experience and expertise
ers were barraged by media reports matters” Dr. Sepulveda said. “The way
UNDERLYING ISSUES AND of problems with mesh midurethral to preserve and improve our current
EARLY TREATMENT slings. Although there are risks with clinical standards is through an evidence
While a number of common factors all continence surgical procedures, Dr. based approach, we are all part of the
can be responsible for stress urinary Sepulveda says that clinical evidence process, patients, scientists and health
incontinence, including advancement in should be the basis of a decision on professionals. We do not want to imag-
age, a history of multiple natural child- the type of treatment of urinary stress ine going back to the old treatments
births and obesity, some women find incontinence. “A television commercial where the risk of complications is
that mundane activities such as sneezing, from a law firm explaining the poten- higher, the efficacy is lower and recovery
coughing and laughing can cause urine tial risk of any type of intervention is longer, based on anecdotes or a lack of
leakage. not news and definitely not medically knowledge of the reliable medical and
“Simply explained, when pressure sound, regardless of how many times is scientific evidence available today.”
is exerted on the bladder through
activities ranging from a simple sneeze Dr. Jaime Sepulveda’s practice is located at 6200 Sunset Drive, Suite 504,
to a good exercise session, urine can in South Miami. For more information, call 305-669-6267 or visit
leak out through a poorly supported www.miamiurogynecologycenter.com.
urethra,” said Dr. Sepulveda. “Think of

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