AI - Hello Dr Brown, You are no doubt aware of your patients - who have had TVT's for stress incontinence - being written to by Shine lawyers asking them if they want to join their class action against the product. How does this make you feel?
DrB - I'm upset that my patients are being fed what I consider misleading information on their treatment but understand that there was a subpoena issued by a Sydney court which health funds have obeyed. The silent majority of patients have seen this as a gross breach of privacy and I agree. I have clearly explained in my last blog post that vested interests have deliberately created confusion between the TVT for incontinence and the problematical prolapse meshes. They are separate problems, products and operations.
AI - How long have you performed TVT's?
DrB - I have performed over 2000's retropubic TVT's since 1998 so have extensive experience not just in performing them but also managing their aftercare. I tell people its my favourite operation because it works so well and people find it lifechanging.
AI - Is it lifechanging?
DrB - I think it is. In gynaecology many women in their 50's and 60's tell me their greatest fear is "becoming a wet old woman". The most common mechanism of how this happens is that untreated stress incontinence leads to a woman voiding urine more often in order to avoid leaking. If no action is taken the urinary frequency increases until habit makes it hard to go past a toilet and she knows where all the toilets are in her locale. The bladder gets smaller and becomes overactive which is unresponsive to many treatments especially the longer it goes on. Instead of the early fix of the TVT, years later the bladder becomes almost like a prune and an indwelling catheter is sometimes the end result.
AI - What do you see happening with the class action?
DrB - I think in the end the difference in the products will become clearer. I hope the women who have suffered with the prolapse meshes gone-wrong will be compensated. I do not think Shine will convince the court that TVT's are the same thing as the prolapse mesh because there is overwhelming data dating back over 20 years that they are safe.
Of course I speak for the retropubic TVT here, which is the sling I perform for my patients. I think Shine will be the only ones who gain from them trying to scare women into joining up to their scheme. The fine print of their contract assures that.
AI - And if you are wrong?
DrB - The TVT would be withdrawn and there would be no option for the treatment of stress incontinence, apart from pelvic floor exercises and unproven charlatan options such as the "chair" or "laser".
Given up to 12% of women report moderate to severe stress incontinence after their family is complete ( https://www.ncbi.nlm.nih.gov/pubmed/17012448 ) all pregnant women would need to be offered a ceasarean section for their birth as a preventative measure. Already younger surgeons are becoming deskilled and more disinterested in pelvic floor surgery making the case for ceasarean birth stronger.
The rate of ceasarean birth would continue to rise until factors such as antibiotic resistance making ceasars more risky or women actually lobbying or demanding a return of the TVT took place.
AI - Sounds like this is an important issue for all women. Let's see how it turns out and I'm sure you'll talk to me again!