I mixed my recent holiday with the serious business of learning and went to the International Urogynaecology Association annual meeting in Vienna.
It was interesting in many ways and reminded me of how isolated Doctors in Australia and Newcastle can become when it comes to current thinking.
Part of the mesh debacle was caused by some doctors nearing retirement overusing mesh knowing fine well they would not be there in 5 years when the problems were surfacing.
This issue still holds - recently I met a patient who was being encouraged to have a hysterectomy by a surgeon close to retirement. She had a severe overactive bladder and hysterectomies make this worse. I advised against the hysterectomy and we found an alternative with the woman understanding that I will be here to look after her in the future.
In the conference several things became clear.
The retropubic TVT in experienced hands is the gold standard treatment for stress incontinence that has not responded to exercises.
Laser treatments are not as safe as some want us to believe and a report of a severe burn causing a fistula really spoilt the party. I also have seen vaginal burns from lasers and they are very hard to treat properly.
Robots are trendy and industry smells money. It reminds me of how mesh started. In the USA 40% of surgery is now with robotics and the early evidence is its largely pointless in gynaecology for the patient but lucrative for doctors.
I have looked into robotics for a minority of my surgeries but the costs to the patient of the disposable equipment put me off - about $3000 that the fund won't cover.
Outcomes are marginally better if at all in gynaecology - although the real benefit is for the surgeon who gets to sit down during the procedure.
Many keyhole surgeons get sore backs and if you choose the robot you can be reassured your surgeon will be protecting their back and is grateful for your help with that.