Some women who have seen me recently with stress incontinence have seen how upset and concerned I have been with the possibility that the company that makes the best slings for stress incontinence could actually withdraw them from use.
A nice lady even said to me "Maybe you should go lie down and have a nice cup of tea."
My worst fears have been confirmed with this email from the Royal ANZ College of O&G coming today.
It says
"...Johnson&Johnson are placing on hold all Gynecare TVT products in Australia and New Zealand effective 17 January 2018. While TVT products supplied before that date may continue to be used, no new orders will be shipped. The information we have is that TVT products will be unavailable for most of 2018.
I would like to reassure all Fellows that there is overwhelming evidence of the safety and efficacy of mid-urethral tapes for stress urinary incontinence. You can view the Cochrane review here.
The College obviously has no control over commercial decisions of device manufacturers, but we view this as disappointing news." Steve Robson President RANZCOG
I would like to reassure all Fellows that there is overwhelming evidence of the safety and efficacy of mid-urethral tapes for stress urinary incontinence. You can view the Cochrane review here.
The College obviously has no control over commercial decisions of device manufacturers, but we view this as disappointing news." Steve Robson President RANZCOG
To me this is a victory for book burners and stupidity.
So now what?
Exactly. Shine lawyers and the corporate media did not think or care of that one.
The only choice now, other than pelvic floor exercises is an operation first described in 1961 and is well acknowledged as a nightmare to perform and to recover from. A Burch Colposuspension.
As a trainee surgeon I never saw a more poorly done and bloody procedure. I once saw a surgeon of over 30 years experience virtually walk out of theatre in the middle of doing one. Think about that. Walking away from the table.
Only a few of us will remember how to do one and I feel sick at having to revisit them. They also cause such scarring that further surgery is hard to do.
So now what we are left with is this....
No specialist trained in the last 15 years will now know how to treat stress incontinence as they will not have even seen a colposuspension.
It scars the bladder like no TVT ever does but it has no mesh....only permanent sutures. Well... thats ok then?
Its a week in hospital rather than one night. An indwelling catheter for possibly weeks rather than a night or two.
I'm aghast but not surprised. I put this very fear out in the open in a talk I did to GP's late last year. In my other blog post on this subject, I did have a vision that these strange times were going to lead to backward steps for women with incontinence. A cruel, declining condition, where some women do not even want to leave the house.....who speaks for them?
For obstetrics I also see big ramifications.
Any woman who plays sport or exercises and is having a first baby, I will now offer an elective caesarean section as protection for the pelvic floor.
Why? because we no longer have a straight forward, acceptable treatment for stress incontinence. Pregnancy and birth are the number one risk factor and we know that a caesarean section protects against stress incontinence by a factor of 3.
Family Planning
Pregnancy
Obstetrics
Gynaecology