No Mesh An Overview By Dr. Raz
I don’t know how many times women have asked me did I have anything written by Dr. Raz to do with mesh complications or the translabial ultrasound. Well it turns out as I searched for a good article about the ‘Crisp’ method of repairing a severe prolapsed bladder to explain to a woman’s family the type of repairs Dr. Raz now does, I came upon a fantastic article written by him and a colleague Dr. Una Lee.
First you may wonder what the Crisp method is and I found an explanation in this article. Education is the best prevention, so as not to wind up like the thousands of mesh injured women like me and all the women who come to this blog. So we all need to read, read, read and become educated about our bodies and what happens if we need surgery.
What is the crisp method? This article states that “CRISP” means (Cystocele Repair using Interlocking Sutures of Prolene) and this procedure is a promising alternative to mesh repair. I know some women are worried about what will happen in the future if they do need a prolapse repair or if they have a severe prolapse and they do not want mesh used in their bodies.
It is hard to understand what this method entails so I Googled to try to find a diagram so that you can understand and I found this one also by Dr. Una Lee and Dr Raz.
This is the explanation of the Crisp Method that I took directly from this article,
Grade 4 cystocele continues to be a challenge in pelvic floor reconstruction. The traditional anterior colporrhaphy has a high recurrence rate. Mesh-augmented cystocele repairs have better anatomic results, but higher complication rates. An alternative to mesh is the use of permanent sutures to provide a net of support. A brief description of the new procedure, Cystocele repair with interlocking permanent suture is as follows: a vertical incision is made from the bladder neck to the vaginal cuff and carried out laterally. 2-0 polypropylene sutures are used to incorporate the obturator and perivesical fascia bilaterally for lateral support. Mattress sutures of 2-0 polypropylene are placed to repair the central defect. The lateral sutures then are interlocked with the central ones (see Fig. 3). The sutures then are tied, thereby reducing the cystocele and creating a supporting net. The vaginal wall is excised asymmetrically and closed as a rotational flap. Preliminary data show significant symptomatic improvement and improved quality of life. The technique has been modified to address early treatable complications, such as incidences of exposed 2 to 3 mm of suture, which was treated in office, and one case of ureteric obstruction, which was treated endoscopically. The “CRISP” (Cystocele Repair using Interlocking Sutures of Prolene) procedure is a promising alternative to mesh repair. Long-term data on outcomes is needed and forthcoming.Fig. 3
If you know that you have a major prolapsed organ, you should discuss this with your surgeon, but in the meantime you need to understand what this procedure is. None of us can bury our heads in the sand any more and we must understand what can be done to help us so that we can ask those very important questions, before we have any surgery.
The following article will give you many explanations of women’s issues regarding organ prolapse.
Grading and staging of prolapse. Page 4.
The use of mesh in prolapse surgery Page 5.
The use of the translabial ultrasound begins on page 5 and continues on page 6
Do the benefits of using mesh outweigh the risks? Page 6
Explanation of the Crisp repair. page 7
When you get through reading this you will find a list of other articles written by these doctors, Dr. Rodriguez and Dr. Kim.
To read the complete article please go to this link http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3021192
As always I hope this will help the many women out there who wonder how they can be fixed when they have severe complications of organ prolapse. Knowledge is our power.