Mesh Midurethral Slings Are the Best Treatment Option for Stress Urinary Incontinence

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Miami's Community Newspapers
Dr. Jaime Sepulveda

Stress urinary incontinence is a complicated term simply defined as the unexpected leakage of urine due to physical pressure placed on the bladder. It is a problem experienced by as many as one in three women in the United States. At a minimum, the condition can be embarrassing and annoying. For some women, stress urinary incontinence can profoundly affect their quality of life. After all, one of the primary rites of passage during the toddler years is the ability to hold one’s urine. Any reversal of that basic achievement in adulthood can be traumatic and stress-inducing.

The Best Treatment

Urogynecologist Jaime Sepulveda M.D. has successfully treated more than 2,000 women suffering from stress urinary incontinence using a device known as the mesh midurethral sling. The sling is placed using local anesthesia during a 25-minute outpatient procedure. 

According to Dr. Sepulveda, the American Urogynecologic Society and nine other worldwide medical organizations concerned with female pelvic medicine, the mesh midurethral sling is the safest, most effective and durable treatment for stress urinary incontinence.


“Cure is more important than improvement” explained Dr. Sepulveda.  “The highest level of medical-scientific evidence demonstrates that in the treatment of clinically confirmed urinary stress incontinence conservative treatments such as pelvic floor exercises and behavior modification will only improve the condition, whereas the mesh midurethral sling will cure it. After more than 2,000 documented studies, the science is crystal clear on the efficacy, durability and safety of midurethral synthetic slings for the treatment of urinary stress incontinence.”

In fact, there have been more studies completed on the mesh midurethral sling than almost any other medical procedure in history. And in 2016, the American Urogynecologic Society issued a statement touting the procedure as the safest and most effective treatment for stress urinary incontinence.

Underlying Issues and Early Treatment

While a number of common factors can be responsible for stress urinary incontinence, including advancement in age, a history of multiple natural childbirths and obesity, some women find that mundane activities such as sneezing, coughing and laughing can cause urine leakage.

“Simply explained, when pressure is exerted on the bladder through activities ranging from a simple sneeze to a good exercise session, urine can leak out through a poorly supported urethra,” said Dr. Sepulveda. “Think of a stretched dock line holding a boat a float, it will easily sink with weight. A miduretrhal sling replaces the stretched or broken supporting structure of the urethra, the tube valve that keeps urine in the bladder.”

As recently as the 1980s, the primary treatment for stress urinary incontinence was placing sutures at the junction of the urethra and bladder, a very sensitive area. This required general anesthesia, an abdominal incision and a lengthy recovery period.  Not only was there a risk of complications from this major surgery, in some cases the sutures caused obstructions, difficult urination and contributed to bladder overactivity. Unfortunately, new problem of urinary frequency, urgency and incomplete bladder emptying were created complicating the treatment of the initial issue.

The solution was straight out of “Back to the Future.” Polypropylene sutures had been widely used in operating rooms for 50 years. A finely knitted mesh sling was invented using the suture material and found to be well tolerated by patients, safe and durable. Studies and more studies were conducted, all finding the mesh midurethral slings to be the safest and most effective treatment option. Studies were undertaken to unprecedented quality, scrutiny and follow up. The most recent ones evaluate the experience seventeen years after the initial surgery.

Show Me the Facts

In the past, American consumers were barraged by media reports of problems with mesh midurethral slings. Although there are risks with all continence surgical procedures, Dr. Sepulveda says that clinical evidence should be the basis of a decision on the type of treatment of urinary stress incontinence. “A television commercial from a law firm explaining the potential risk of any type of intervention is not news and definitely not medically sound, regardless of how many times is shown.”  Dr. Sepulveda said.  “There is a possibility that mesh midurethral slings may no longer be produced because of a type of litigation that has a disconnect from the current medical and scientific evidence.”

Synthetic midurethral slings are the current clinical standard for the treatment of urinary stress incontinence. The use of midurethral polypropylene implant is supported by over 2000 medical studies and the prestigious Cochrane Scientific Collaboration (cochrane.org). As with other implants used in the human body to replace defective tissue or a broken structure a risk of revision exist with synthetic midurethral slings. Revision is the professional term used to describe a reintervention for a surgical procedure or an implant. It is a risk that exists even if your own tissue is used. When studied at 10 years, the risk of requiring a midurethral sling revised is as low as 2%-3%. For comparison, joint replacements have a 6 % to 12% rate of revision and breast implants are revised at rates over 25%.

Patients suffering from stress urinary incontinence should prepare ahead of their consultation in order to have a relevant, evidence based conversation about their surgical options. Professional societies such as the sites of the American Urogynecologic Society, The American Urological Association, The International Urogynecologic Association and the Cochrane library are reliable sources conversation.  “Your surgeon’s experience and expertise matters” Dr. Sepulveda said. “The way to preserve and improve our current clinical standards is through an evidence based approach, we are all part of the process, patients, scientists and health professionals. We do not want to imagine going back to the old treatments where the risk of complications is higher, the efficacy is lower and recovery longer, based on anecdotes or a lack of knowledge of the reliable medical and scientific evidence available today.”

Dr. Jaime Sepulveda’s practice is located at 6200 Sunset Drive, Suite 504, in South Miami. For more information, call 305-669-6267 or visit www.miamiurogynecologycenter.com.


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33 COMMENTS

  1. From the cochrane.org site “The risk-benefit profile means that transvaginal mesh has limited utility in primary surgery.”

    This article is only selling his work. He is giving out misinformation concernant the studies i.e. Cherry picking.

  2. Would you let a surgeon operate on you if he were blind, deaf and dumb? Dr Sepulveda must have all of these disabilities if he believes that anything made of plastic mesh would be safe implanted in our bodies. Just have some put inside yourself doctor, then tell us how you feel after a few years. This device is ruining and taking lives around the world! I know because I am one of the injured!

  3. There is no safe plastic mesh product, as shown by the thousands of lawsuits now in play which incontrovertibly prove that the pain and suffering caused by mesh implants is a much more important and crippling effect than the medical community at large is willing to admit.

    It is easy to research. Search for mesh pain, mesh sling problems, or look for mesh groups on Facebook. Hernias and female incontinence are the larger part of the injured and crippled population of mesh victims.

    Estimates are as high as ten percent of the patient population is injured by mesh. Millions of mesh insertions each year amount to hundreds of thousands of victims world wide. Mesh has been virtually outlawed in Scotland, and some other countries.

    Mesh removal is becoming a more sought after skill as more patients seek help, releasing them from a horrific existence of pain management and inactivity due to the crippling nature of the stuff.

    Please do your research. Do not agree to letting any surgeon who cites mesh as the only way to fix your hernia or incontinence operate on you. So many of us have learned the hard way…

  4. Placing a medical device capable of causing catastrophic injury or death for a non-life threatening medical condition is not the best treatment. Only a fool would think so.

  5. How on earth do you come to that conclusions, so many suffering because of this quick fix. It doesn’t work for so many and the pain and suffering it course’s it,s just not worth going down that route. The complications far outway the need to use this. It,s plastic, plus it,s sopposed to have been banned because the risk far outweigh the benefits, there are none. The damage it does to the body is beyond belief, I know because it,s happening to me and thousands of other people, men ,women, please, I beg you stop using the cheap alternative because it,s cheap and easy to do. Train doctor’s to do it the old fashioned way, train surgeon,s to remove it. Above all stop denying are problems and pain are not to do with mesh. We have had enough

  6. I’m in constant pain, continual infections, have mesh eroded into my vagina. With only a handful of surgeons in the world willing to fully remove the mesh I’ll likely never have sex again. Say NO to mesh.

  7. This surgeon hasn’t got a clue! How arrogant can he really be??? Maybe he should have one of these toxic devices put into him and see how he deals with all the pain and suffering it is causing so many people. How dare he sit there and say that putting plastic into a human body is safe. For surgeons it’s the ‘quick fix’ option and also lines their own pockets with the commission they receive from the pharmaceutical companies!

  8. You arrogant person. Until you’re female and have had this life destroying surgery done, you may NOT comment about it…let alone do the surgery. How dare you. Hundreds of thousands lives ruined worldwide. Dollars before lives. Global greed is growing

  9. Mesh Midurethral Slings are exactly what ruined my life and mutilated my vagina. How about you wrap that mesh around your manhood and report back here in a year or two?

  10. Literally tens of thousands of patients around the world are suffering with symptoms of rejection of this implant, adhesions, severed tissue, embedded, twisted mesh in their tissues, erosion and even severed tissue and organ structures. How can you hold your head high as a medical professional who has taken an oath of care in the face of so much suffering? One answer – $$$$

  11. Worldwide women are suffering from mesh implants, special mesh clinics are being established To treat and remove mesh implants! Class action legal cases have been established against Mesh produces and in my humble needs to include Doctors who continue to torture women with these implants!

  12. This product doesn’t work!!!!
    Gold standard my arse.
    All seemed well for the first 3 weeks post surgery then the cover up began. Told there’s nothing wrong.
    Told everything is perfect.

    I’ve had blood on my urine for 2 years now. I have been diagnosed with artery and nerve damage directly caused by the sling being inserted.

    The pain is unbearable, told I can never ride a horse or bike ever again. On pain medication full time. Sex life destroyed. I was 34 years old.

    My life is completely ruined from this “Gold standard” plastic price of 💩 sling your selling.

    How much money do you make for this surgery?
    What kick backs are you getting from the manufacturer?

  13. Ill show you the f..ing facts. I hope for the womens sack that this butchers fact are right but they wint stay that way. This product leads to chronic pain, ill health and worse. Dont let this man mislead you.

  14. Well I’ve heard it all now. What a load of lies. The most researched device in history. You know that is a lie. It was never tested in humans at all before use. Why do you think 100s of 10000s of women have won court cases against the manufacturers. So all the judges are lying too. This device is the most cruel untested torture device ever to be implanted in women.you are a disgrace to the medical profession when you know what devastating harm this device does unyet for your wallets sake you will put womens lives at risk. Shame on you.

  15. What a complete and utter ignorant self minded person who are, only interested in lining your own pocket at the expense to those you have operated upon causing them grievously bodily harm by using mesh in your trustworthy patients. I hope you sleep well at night. You ignoranus selfish human being

  16. Would you implant this in your mother, daughter, sister? If not then you’re a hypocrite, if yes then you’re a narcissist. Either way, you & all the other implanting surgeons should be on trial for manslaughter. But since the corruption & greed runs too deep, we will call you all out one by one. No longer will you all tell women that their pain is ‘in their head’. No longer shall we be pushed aside & treated like 2nd class citizens. The global genocide of mesh implanted/injured/dying women, are becoming way more aware. Guess you had better find another easy money-spinner.
    Oh, & forget jumping on the removal gravy train. We’re onto that one as well!!

  17. I wish Docs spent time with the men and women who’s lives they have destroyed with these mesh products. Not to mention the lives of their spouses. It’s such a quick, easy money maker for you that you have totally lost view of the most important part of being a doctor. Yes, there are many people that don’t have issues with this garbage implanted in their bodies but there is an alarming amount that do. When will the U.S. medical industry pull their heads out of their pocketbooks and remove this crap from the market? These products should be taken out of 510(K) and require PMA at minimum! Contact some of the people commenting and listen to their stories. I guarantee it will make you think. I’d be glad to tell you how badly this industry has decimated my family.

  18. I challenge this publication and dr sepulveda to give me list of his 2000 successful patients for me to follow up with. I guarantee you there have been complications. I would also like to see the study that is referred to that followed up 17 years after the surgery. I have never seen this document and would be quite interested. As a newspaper, please do your research and present the other side of this story. These doctors have no clue the real long term effects if mesh and how many lives they have ruined.

  19. Well after reading some of the above post I must agree that you must be getting paid to write such an article.

    If you are being paid or manipulated to write such a post and it does come out you will be dragged into court and will be facing law suits yourself.

    If you don’t read and listen to the information that 10s of thousands of women and men have given. Then you my dear are no doctor.

    I’m not going to go on about how this has affected me. Will take to long and I want you to really look into this on the other shoe.

    My life is no life and reading post like this from a doctor just blew me away with your arrogance.

    So I’m going to wait to see the day you are dragged into court. It’s not a matter of if but when. Because there will be women out there who’s lives you have destroyed.

    So if there is one thing you do today look into the lies surrounding this mesh.

    And if you don’t then I hope that karma kicks your door down.

    I would say have a good day! But I can’t I will tell you have a check your morals out day.

  20. Really !!!! Has he had this inserted into his body and suffered the consequences? Mysterious illnesses manifesting which makes you think you are going crazy. Pain within day so that by the 6 weekly post operation check you have difficulty walking and having to use a walking stick. Now, years later the problem is back as bad as it was before surgery so what happened to the mesh. BTW, I was not informed that plastic and metal was going to be inserted into my body. If I had known I would never have signed any forms pre surgery. Now have a herniated stomach that NO SURGEON will ever get near as I am treating it with natural medicines instead of invasive and crippling surgery.

  21. I am one of the many injured by mesh currently attempting to have this removed in the UK.I have one question for you “would you allow a family member of yours to have mesh?” If the answer is yes god help your family.

  22. There are countless women (myself included) that have suffered from the meshes. They can have long term health ramifications. There are ways to use your own tissue to fix stress incontinence. Do no put foreign bodies (window screen) into your body. please. These law suits are very real.

  23. For me the sling worked. Stopped the leaking. Entirely. In fact I couldn’t pee at all for days after surgery. Had to catheterize myself for weeks. Finally when everything began to normalize and I could pee again, the pain struck. Lightning bolts, electric shocks, fire, burning, burning. Did my implanting surgeon, or any of the specialists I went to help? No, because I had received the gold standard best treatment option, so the pain was just in my head. A psychiatrist would do. Months of pain, and finally, total sling removal by a compassionate skilled surgeon in a different country, thousands of dollars spent, physical therapy, and medication to get a semblance of my life back.

  24. That 17 year study I suspect is the Nilsson study (2013).

    It recruited 90 women, but 38% of them had dropped out by the end of the 17 years (that’s a rather high drop out rate for a study). 12 of the participants were interviewed over the phone rather than examined, and 11 women had died by the end of it. The average age of the participants was 54, with the oldest being in their 80s when the mesh was implanted, meaning that a lot of the cohort would not have been very sexually active, so side effects like painful intercourse (which a lot of mesh victims suffer from) may not have been picked up on. The paper defined “success” as the women maintaining continence. But no mention of them asking about any other issues – like the pain and suffering that thousands of mesh victims hare suffering.

    The lead authors were paid Ethicon consultants. Now I appreciate that in science the most important thing is the evidence, and that if a paper stands up to scrutiny then it shouldn’t be discounted just because it has been funded by industry. But when you have a small-ish study, with a high drop out rate and a term of reference that doesnn’t appear to ask about quality of life complications, not sure this one counts as great evidence that mesh is this wonderful thing

  25. How can he ignore research like this?

    http://www.ncbi.nlm.nih.gov/pubmed/18801499
    There were 928 MEDLINE citations for sling and complications, 279 for sling and complications and bladder, and 68 for sling and complications and voiding dysfunction. The reported complication rates ranged from 4.3% to 75.1% for retropubic and 10.5% to 31.3% for transobturator mid urethral slings. Complications included bladder perforation, hemorrhage, bowel injury, vaginal extrusion, de novo urgency and urge incontinence, urinary tract infections and voiding dysfunction. Retropubic mid urethral slings led to a higher occurrence of complications such as bladder perforation and hematoma. In addition, the retropubic approach resulted in serious complications such as bowel injury, major vascular injury and death. Groin pain was more common after the transobturator approach. Experimental studies indicated that the potential mechanisms for sling complications may include vaginal dissection, denervation injury and bladder remodeling.
    CONCLUSIONS:Mid urethral slings result in bothersome complications which should not be minimized. Awareness of these complications should encourage improvements in patient counseling as well as further investigation of the underlying mechanisms. Decreasing complications should be considered an important outcome for future clinical studies of mid urethral slings.
    http://commonhealth.wbur.org/2011/11/surgery-under-scrutiny-what-went-wrong-with-vaginal-mesh
    Complications Rising …..Last year, a clinical trial comparing vaginal mesh for prolapse to traditional surgery using women’s own ligaments for repair was stopped early due to excessive complications, with more than 15 percent of patients experiencing mesh erosion. The New York Times quoted the lead author of the report, Dr. Cheryl B. Iglesia, director of female pelvic medicine and reconstructive surgery at Washington Hospital Center in the District of Columbia, saying: “The bottom line is not only there were more complications, but the mesh didn’t prove any better than traditional surgery.

  26. Your comments regarding slings are both ignorant and insulting to the thousands that have suffered debilitating complications due to Mesh ( not tape, slings nor hammock) but mesh that has caused permanent life changing damage. The trials were paid off to look good, how many were then approved on an already cancelled device due to the number of failures! Are you paid my a mesh company for your comments!

  27. I’ve had my life and family destroyed by a mesh implant that I was never told I was having. Doctors use a play with words calling it tape, sling, hammock etc to lure and deceive trusting, innocent women into having mesh surgery, telling them it will greatly improve their quality of life (BULLSHIT). Yet when complications arise they turn their backs telling women it is all in their heads. Doctors who continually defend and use jagged edge mesh inserted with razor sharp hooks into a womens most sacred and sensitive bodily part are butchers who are solely in this mesh business for greed and profit. Do not believe this article as it is the pharmaceutical Companies and mesh manufacturers who sponsor these surveys. They never interview mesh injured women because they are afraid the truth will effect their bank balance. This article is all LIES. SAY NO TO MESH.

    • Well said Maggie. Pro mesh profiteers never interview women harmed by mesh from our online support groups. they have no idea of the true number of complications. Many patients refuse to go back to the surgeons who said complications were rare. That was the first lie. Why would anyone go back to a surgeon they now can no longer trust. With no medical device registry, misdiagnosed mesh complications (the most common one being interstitial cystitis) they have no clue of how much harm they have done. Arrogance and butt covering is the next thing that closes minds to search out how many they have injured. I hope you are now on a healing journey.

  28. I had a polyurethane mid urethras sling implanted in 2004, which I thought was fantastic for a few years. Then the problems started; frequent UTI’s, chronic fatigue, prickly pain in the pelvis. The doctors told me that it wasn’t the sling. I then got a chronic infection that lasted for months. I followed my intuition and had the mesh removed and the doctor found that it was infected with bacteria and it was embedded in my bladder as well as in both hip bones and it was scarring my urethra, which needed to be repaired. The mid urethras sling is a profitable procedure for doctors but dangerous for patients. It’s inserted through the vagina, which isn’t a sterile environment so it becomes infected and remains in the body causing serious immune issues. Anyone who believes this toxic substance is safe, is a fool.

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