Letter: Anterior urethropexy offers excellent, low-risk option to mesh

July 12, 2019

"Practicing medicine is difficult enough these days without doing things to enrich innovation-stifling lawyers," writes Jack Francis, MD.

To the editor: 

As an old retired urologist, I’ve seen and done most of the procedures used for treatment of stress urinary incontinence. With the litigious world of today, I am befuddled why anyone would want to expose themselves to a lawsuit by doing any of the mesh procedures when an excellent, low-risk, highly successful procedure is available.

The anterior urethropexy (Lapides, MMK, Burch) uses absorbable suture (gut) and can be done laparoscopically, robotically, or with a short transverse muscle-splitting incision. Success should be in the 95% range. The procedure can be individualized to suit the skills of the urologist. It basically results in fixing the anterior urethra, bladder neck, and bladder dome anteriorly to the periosteum of pubis and rectus fascia.

Admittedly there are negatives, although not many. Overnight stay may be necessary, and a catheter may need to be left for 1-2 days. But pain is usually mild. Urinary retention is rare, as are long-term complications.

Sometimes modifying older procedures is comparable to devising new ones. Practicing medicine is difficult enough these days without doing things to enrich innovation-stifling lawyers. Watch TV some night and note the ads for nonsensical lawsuits. Best of luck.

Jack Francis, MD / Laytonsville, MD