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Ethicon Media Monitoring 01/06/2017
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Judge Says $13.7M Judgment for Defective Mesh Should Remain
Jan 5, 2017 | The Legal Intelligencer
By P.J. D'Annunzio
A Philadelphia judge presiding over a transvaginal mesh case that resulted in a $13.7 million judgment said the award should not be disturbed on appeal. -
NJ Appeals Judge And Mass Tort Jurist Carol Higbee Dies
Jan 5, 2017 | Law 360
By Bill Wichert
A New Jersey state judge, well known for presiding over mass tort litigation involving pharmaceutical giants such as Johnson & Johnson and Hoffmann-LaRoche Inc., died on Tuesday at the age of 66. -
Pelvic Mesh and Hernia Mesh- Is There Any Difference?
Jan 5, 2017 | Mesh Medical Device Newsdesk
The origin of the female surgical mesh devices is hernia mesh. It was assumed prolapse was simply the female form of a hernia. -
Transvaginal Mesh Law Firm called a “Mass Tort Warehouse” – A Numbers Game
Jan 5, 2017 | Mesh Medical Device Newsdesk
This story originally ran November 24, 2015, and details the ugly underbelly of the business side of law. The story arises from a lawsuit filed by a former employee whose job it was to obtain millions in litigation financing. Never underestimate the influence of money over law. -
Treating Pelvic Organ Prolapse
Jan 5, 2017 | News- Medical
By Liji Thomas
Pelvic organ prolapse is a common condition in many women following vaginal delivery. It results from the descent of the uterus, urinary bladder, urethra, small intestine or rectum, along with and through the vaginal wall, as a result of weakened pelvic support. -
Pelvic Organ Prolapse Prognosis
Jan 5, 2017 | News- Medical
By Liji Thomas
Prolapse of the pelvic organs is often distressing for affected women. However, many women do not experience any symptoms, and may not be aware of the condition until it is found during a routine pelvic examination.
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Judge Says $13.7M Judgment for Defective Mesh Should Remain
Jan 5, 2017 | The Legal Intelligencer
By P.J. D'Annunzio
A Philadelphia judge presiding over a transvaginal mesh case that resulted in a $13.7 million judgment said the award should not be disturbed on appeal.
In an opinion issued this week in response to Johnson & Johnson subsidiary Ethicon's appeal of the judgment, Philadelphia Court of Common Pleas Judge Kenneth J. Powell Jr. wrote that the state Superior Court should allow the award to stand.
The judgment stems from the case of Sharon Carlino, who claimed Ethicon's mid-urethral sling device failed because it was negligently designed, and that its failure caused her to suffer permanent pain during sex. The device was implanted in her in 2005 to combat urinary incontinence; however, she claimed the mesh was defective because its pores were too small, it had a tendency to degrade, it was overly friable because it was cut by a machine and not a laser, and the mesh can erode through the patient's tissue.
After a 14-day trial last February, a jury awarded Carlino $3.25 million in compensatory damages, $250,000 to her husband for loss of consortium, and $10 million in punitive damages. Delay damages in the amount of roughly $240,000 were later awarded.
Ethicon had asked the court to either enter judgment notwithstanding the verdict, grant a new trial, or reduce the verdict award. In doing so, Ethicon raised several arguments for why the jury's verdict should be reversed, including statute of limitations, inadequate jury instructions, and evidentiary disputes.
Powell disagreed with Ethicon's argument that the punitive damages should be remitted because there was no evidence Carlino's injuries were caused by "actual malice" or "wanton and willful disregard" for the potential harm to a patient.
"The evidence of defendant-appellant's wanton and willful disregard for plaintiff adequately supported the jury's award of punitive damages," Powell said.
He added that the jury was entitled to find from the evidence that Ethicon deceptively withheld informations about the risks of having a transvaginal implant.
"The jury was free to determine that Ethicon provided warnings so deliberately misleading as to warrant the imposition of punitive damages," the judge said.
Powell also held firm on the issue of compensatory damages in response to Ethicon's argument that they be remitted as well. Ethicon argued that there was no testimony as to past or future medical expenses, and characterized her pelvic pain as intermittent.
"To characterize her pain this way is to minimize her damages to an unreasonable degree, even as a defense argument," Powell said. "This is not merely 'intermittent' pain—it is chronic pain, pain that will be with her for the rest of her life, with no real prospect of resolution."
Ken Murphy of Drinker Biddle & Reath represented Ethicon and declined to comment on Powell's opinion.
Shanin Specter of Kline & Specter, who represented the Carlinos, said he is "very optimistic" the Superior Court will uphold the judgment.
http://www.thelegalintelligencer.com/id=1202776195524/Judge-Says-137M-Judgment-for-Defective-Mesh-Should-Remain?slreturn=20170006013559
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NJ Appeals Judge And Mass Tort Jurist Carol Higbee Dies
Jan 5, 2017 | Law 360
By Bill Wichert
Law360, New York (January 5, 2017, 8:52 PM EST) -- A New Jersey state judge, well known for presiding over mass tort litigation involving pharmaceutical giants such as Johnson & Johnson and Hoffmann-LaRoche Inc., died on Tuesday at the age of 66.
Appellate Division Judge Carol E. Higbee was remembered Thursday by her fellow jurists for her kind demeanor and even-handed approach on the bench, where she showed a tremendous work ethic and treated everyone with respect.
“She was just a wonderful person and we're all very, very sad here,” said Julio L. Mendez, assignment judge in the Atlantic/Cape May vicinage, where Judge Higbee previously served as presiding judge of the civil division.
“She had all the qualities that make a good judge,” Judge Mendez told Law360, adding that those traits included Judge Higbee's “work ethic, competence, independence, caring about doing the right thing, treating people with respect and dignity.”
“She had it all — and she did it in a quiet, but effective way,” he said.
New Jersey Supreme Court Chief Justice Stuart Rabner said in a Thursday statement that Judge Higbee “devoted herself to the administration of justice for 24 years on the bench.”
“Her reputation for judicial scholarship and fair, even-handed treatment of all litigants was well deserved. She will be sorely missed by her colleagues and friends in the Judiciary,” Justice Rabner said. “Her passing is truly a loss to us all.”
A former civil trial attorney specializing in medical malpractice, product liability and personal injury cases, Judge Higbee was appointed to the bench by former Gov. James Florio, and she took her oath of office on Feb. 19, 1993. She served as a civil judge in Atlantic County for 21 years and was named presiding judge of the civil division there in 2005.
Before moving to the Appellate Division in 2014, Judge Higbee oversaw mass tort litigation against Johnson & Johnson over its antibiotic Levaquin, against Merck & Co. Inc. over its osteoporosis drug Fosamax and against various brand-name and generic manufacturers of the heartburn drug Reglan.
In mass tort litigation against Hoffmann-LaRoche involving gastrointestinal injuries allegedly caused by its acne drug Accutane, the drugmaker sought to remove Judge Higbee from the litigation in December 2012, claiming that she appeared to be biased in favor of the plaintiffs.
In seeking Judge Higbee's recusal, Roche cited a series of rulings and statements made by the judge against the drugmaker, including comments she made at a defense bar conference while sitting on a panel with an attorney for the Accutane plaintiffs. Judge Higbee refused to take herself off the cases in February 2013, saying that though actions by Roche's attorneys made it difficult to appear impartial, she did not favor the plaintiffs.
Roche challenged the decision, but in January 2014 the New Jersey Supreme Court denied its request to remove Judge Higbee from the litigation.
Later that year, Judge Higbee refused to overturn an $11.1 million jury award for a South Dakota woman who said a Johnson & Johnson unit’s vaginal mesh product caused debilitating nerve pain, ruling overwhelming evidence and an appropriate jury award obviated a new trial. A state appeals court in March 2016 upheld the jury award.
When her appointment to the Appellate Division was announced in July 2014, Judge Higbee said in a statement: “I love the law and have been fortunate to work with so many wonderful people throughout my judicial career. I am grateful for the opportunity to serve the public as an appellate judge, and I look forward to the new challenges that await.”
In the Appellate Division during the past year, Judge Higbee sat on an appellate panel that in August denied a New Jersey news outlet's bid to access the identities of New Jersey Gov. Chris Christie administration figures who had sought legal representation amid the investigation of the George Washington Bridge lane closures, ruling that the information isn’t a public record.
Judge Higbee was part of the appellate panel that in June carved out an exception to the two-year deadline for filing medical malpractice suits when it ruled a suing woman who didn’t identify her doctors by name until four years after treatment was thwarted by a hospital’s sluggish response in helping her decipher their illegible signatures. The opinion reversed rulings in favor of two emergency room doctors.
In November, Judge Higbee and two other judges on an appellate panel upheld a lower court ruling dismissing an age discrimination lawsuit against Princeton University from a former construction manager on a library project, accepting the school's argument that the man was fired after there was no longer any work for him.
Judge Carmen Messano, presiding judge for administration in the Appellate Division, said in a Thursday statement: “When Judge Higbee came to the Appellate Division two years ago, she brought to the panel her love of the law, her superb intellect, her easygoing demeanor and her capacity to get to the legal argument at the heart of an issue.”
“We had such a short time with her, and we mourn her passing as a colleague and a friend,” Judge Messano said.http://www.law360.com/articles/877999/nj-appeals-judge-and-mass-tort-jurist-carol-higbee-dies
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Pelvic Mesh and Hernia Mesh- Is There Any Difference?
Jan 5, 2017 | Mesh Medical Device Newsdesk
The origin of the female surgical mesh devices is hernia mesh. It was assumed prolapse was simply the female form of a hernia.
Is all surgical mesh the same?
By now readers of Mesh News Desk understand whether mesh is used for hernia repair, to treat stress urinary incontinence or pelvic organ prolapse, pelvic mesh and hernia mesh is usually made of polypropylene.
Surgical mesh materials can be non-absorbable, absorbable, biologic or a composite. Animals are used to source biologic mesh, generally pig (porcine) or cow (bovine). The intestine or skin is processed and disinfected before being used as an implanted medical device.
Synthetic mesh, such as plastic polymeric polypropylene is more widely used to treat hernias and for gynecologic use, largely because it’s inexpensive and available.
It is a polymer that originated from the oil industry and was isolated for all sorts of uses in the 1950s, including automotive components, carpets, clothing and structural foam, even the lid of a Tic Tac box. PP’s recycling code is a “5” inside the recycle symbol.
PP resin pellets are made into mesh threads and because of its low cost, PP has become the world’s second-most widely produced petroleum-based plastic after polyethylene.
Non-absorbable synthetic mesh is considered a permanent implant and intended to remain in the body indefinitely to provide reinforcement to a weakened abdominal wall, an incision site or prolapsing pelvic organs.
In the 1970s, gynecologists began to retrofit hernia mesh for gynecological use.
It was assumed POP (pelvic organ prolapse) was simply a female version of a hernia, where the uterus, colon or bladder dropped outside the body. The same principles applied – implant the surgical fabric to shore up the descending organs due to the force of gravity and the failure of weak connective tissues.
The first surgical mesh used for female incontinence was ProteGen by Boston Scientific, approved by the FDA in 1996.
But the material, a woven polyester with pressure-injected bovine collagen, was voluntary removed from the market in 1999, branded as adulterated and misbranded, in other words defective.
That didn’t stop at least 60 newer meshes to be cleared by the FDA using ProteGen as a “predicate.”
Naming a predicate is all that is required under the FDA’s fast-tracked 510(K) clearance process. Hernia and pelvic meshes are all classified as Class II or moderate risk, even though safety and efficacy was never established through clinical trials.
By 1998, Ethicon, a division of Johnson & Johnson, played catch up with its Tension-Free Vaginal Tape (TVT). An enterprising Swedish gynecologist, Ulf Ulmsten, MD, approached Ethicon about creating a product to treat stress urinary incontinence (SUI).
Using the Ethicon Prolene hernia mesh, he created the first TVT mesh to treat SUI.
The 2002 Gynemesh, PS, another hernia mesh was configured to become the first surgical mesh to treat POP.
The next evolutionary phase were prepackaged “kits” that would include tools, such as stainless steel trocars, to insert the mesh. The first kits for POP repair were made by American Medical Systems. The AMS Apogee and Perigee System were cleared under 510(k) in 2004.
Along the way, the FDA did not require any additional evidence of safety or efficacy.
Between 1992 and 2010, the FDA cleared 168 applications for surgical hernia mesh for urogynecologic use.
With more than one million hernia repairs in the U.S. annually, non-mesh repairs now represent less than 10 percent of groin hernia repairs, according to the FDA.
What’s interesting is the complications for hernia repair mesh are virtually identical to complications from transvaginal mesh – pain, infection, scar formation, fistulas, mesh erosion, migration, perforation of organs, mesh shrinkage and a recurrence of the original condition. The consistency is often the polypropylene material used for both meshes.
Surgical mesh has become a multi-billion dollar industry that is growing in the U.S., India and China with no signs of slowing down. ###
http://www.meshmedicaldevicenewsdesk.com/pelvic-mesh-hernia-mesh-difference/
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Transvaginal Mesh Law Firm called a “Mass Tort Warehouse” – A Numbers Game
Jan 5, 2017 | Mesh Medical Device Newsdesk
This story originally ran November 24, 2015, and details the ugly underbelly of the business side of law. The story arises from a lawsuit filed by a former employee whose job it was to obtain millions in litigation financing. Never underestimate the influence of money over law.
If you ever called an 800 number advertised on late night television to pursue a possible product liability claim, this might be where that call leads you.
The ugly underbelly of the business of law is exposed in a recently filed lawsuit by a former employee who says he wasn’t paid for his work obtaining millions in litigation financing. The lawsuit reveals the quest to aggregate clients who become no more than “commodities,” including transvaginal mesh claims filed by thousands of women.
In the lawsuit, filed by 30-year-old Amir Shenaq in Harris County District Court, Texas.
The former financier claims Houston high-volume law firm, AkinMears, owes him more than $4.2 million in commissions for securing funding for the firm. Shenaq says he raised $100 million from a hedge fund that provides dollars to purchase thousands of claims from other law firms.
The lawsuits are then bundled and traded among attorneys like home mortgages, reports Bloomberg here.
The complaint, (Case No. 2015-57942), which was sealed, reinforces the idea that all of these cases are just bargaining chips to be run down an assembly line.
“AkinMears is not run like a traditional plaintiff’s law office, and the Firm’s lawyers do not do the types of things that regular trial lawyers do,” like meet clients, file pleadings and motions, attend depositions “or, heaven forbid, try a lawsuit,” Shenaq claims in his suit. “The firm charges 40% for its services which do not include the mundane chores of actually practicing law,” the suit claims.
After lowering the interest on monies borrowed by the firm from 24% to 16% interest, Mr. Akin bought a fifth interest in a Phenom 300 corporate jet for $1.5 million, according to the Forbes story here.
The firm, AkinMears, run by Truett Akin IV and Michelle Mears, uses television and Internet ads to recruit clients who they sign to litigation.
Mr. Shenaq calls the firm a “glorified claims processing center,” because it spent thousands on television ads to run up the numbers of potential clients. Others clients have taken Lipitor, have hip implants or the asbestos exposure disease, mesothelioma.
Shenaq was also reportedly negotiating arrangements with a Dallas lawyer affiliated with four firms calling themselves Alpha Law. Dallas lawyer, Mazin Sbati, was affiliated with the group which had close to 14,000 transvaginal mesh cases.
AkinMears reportedly purchased the cases for $45 million along with another 160 mesh cases. The cases cost about $3,000 each but yielded attorneys’ fees of $15,000. Bloomberg reports it’s not clear where these cases stand or which Defendant mesh makers they name.
The firm hoped to gain anywhere from $130 million to $200 million in profit from the transvaginal mesh lawsuits.
AkinMears initially wanted the complaint sealed because it revealed the business model:“Borrow as much money as possible; (ii) buy as many television ads and/or faceless clients as possible; (iii) wait on real lawyers somewhere to establish liability against somebody for something; (iv) use those faceless clients to borrow even more money or buy even more cases; (v) hire attorneys to settle the cases for whatever they can get; (vi) take a plump 40% of the settlement from the thousands and thousands of people its lawyers never met or had any interest in meeting; and (vii) lather, rinse, and repeat.”
When it came time to pay commissions, Shenaq was fired. “Akin and Mears didn’t pay Shenaq for one reason and one reason only, he says: “They didn’t pay him because they didn’t feel like it.”
The Alpha group is said to be behind much of the lawyer advertising that has diluted the pool of valid transvaginal mesh cases adding many who just have a mesh in place.
AkinMears says it has clients involved in power morcellator, testosterone, Xarelto, Mirena, and Risperdal cases, among others. #
Learn More:
Here is the lawsuit, Shenaq v. Akin, petition has been temporarily sealed in October. Case No. 2015-57942
http://www.texaslawyer.com/id=1202739910841/ExEmployee-of-AkinMears-Sues-Firm-Alleges-Millions-Owed?mcode=0&curindex=0&curpage=ALL
http://www.forbes.com/sites/danielfisher/2015/10/20/lawsuit-details-how-law-firms-borrow-and-pay-millions/
http://setexasrecord.com/stories/510642299-mass-tort-warehouse-fires-fund-officer-to-avoid-paying-him-millions-for-acquiring-14-000-mesh-claims-suit-alleges
http://www.bloomberg.com/news/articles/2015-10-22/inside-massive-injury-lawsuits-clients-get-traded-like-commodities-for-big-money
NYT, October 22, 2015, Should You Be Allowed to Invest in a Lawsuit?
http://www.nytimes.com/2015/10/25/magazine/should-you-be-allowed-to-invest-in-a-lawsuit.html?_r=1
Litigation and Trial Blog, Maxwell Kennerly
http://www.litigationandtrial.com/2015/11/articles/product-liability-2/lucrative-mass-torts-scam/
http://www.meshmedicaldevicenewsdesk.com/transvaginal-mesh-law-firm-called-a-mass-tort-warehouse-a-numbers-game/
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Treating Pelvic Organ Prolapse
Jan 5, 2017 | News- Medical
By Liji Thomas
Pelvic organ prolapse is a common condition in many women following vaginal delivery. It results from the descent of the uterus, urinary bladder, urethra, small intestine or rectum, along with and through the vaginal wall, as a result of weakened pelvic support.
Though it is not a life-threatening condition, pelvic organ prolapse can be a source of much embarrassment, inconvenience, restrictions, and general psychological stress. Self-worth may be severely reduced by having to wear a sanitary pad constantly, for instance, or the fear of smelling of urine may limit one’s social activity. Thus treatment of this condition is of great importance to improve the overall quality of life.Non-Surgical Treatment
Asymptomatic prolapse may not need treatment. Lifestyle changes such as weight loss, and avoidance of heavy lifting, are advised to prevent the emergence of symptoms and to prevent the progression of the conditions.Pelvic Floor Muscle Exercises
Pelvic floor muscle training (PFMT) is thought to be an effective treatment for mild grades of prolapse, or even up to stage 3. PFMT taught one-on-one for 16 weeks to 6 months has been shown to bring about symptomatic improvement. Stress incontinence symptoms are especially responsive. Mild prolapse may be improved by regular pelvic exercises.
They are also called Kegel’s exercises and are best taught individually to make sure each patient understands which muscles to contract and how to exercise them. PFMT in combination with pessaries or surgery may be highly effective in preventing the recurrence of symptoms. This finding needs to be confirmed, however, as other studies have not been able to confirm this suggestion.Pessaries
Pessaries are devices which can be inserted into the vagina, to prevent the vaginal wall from descending by providing mechanical support. They are most suitable for women who have minor stages of prolapse, and for those who cannot or will not agree to surgical repair of their prolapse.
Vaginal pessaries have been known from old times. Modern pessaries come in a variety of shapes and different sizes, to fit specific types and stages of prolapse. Latex and silicone pessaries are available. There is not much evidence on which type and material are best but more than three of four urogynecologists prescribe them as first-line treatment for mild prolapse. With repeated trials, each woman may be able to identify which pessary type and size best relieves her symptoms. These may range from urinary and bowel dysfunction to sexual dissatisfaction. Ring pessaries are the most common type in use.
Pelvic floor exercises in combination with pessary use may be more effective than either treatment used alone. Pessaries should be removed, cleaned thoroughly, and replaced properly every 4-6 months. Sometimes their use may be associated with mild vaginal bleeding, infection, vaginal ulceration, or urinary leakage to a small extent.Hormonal Treatment
Estrogen therapy is useful in strengthening the pelvic muscles, ligaments, and vaginal mucosa, which brings about a marked improvement in pelvic floor strength. Topical estrogen therapy is preferred as it reduces the patient’s exposure to estrogen, and lowers the dosage.Surgical Treatment
Women have a 10-30% risk of pelvic organ prolapse repair in their lifetime. The repair involves support to the organ which is descending by attaching the vaginal vault or the uterus to a ligament in the pelvis or the sacrum.
Pelvic support reconstruction can be carried out through the vagina or the abdomen with equal rates of success. Laparoscopic surgical repair is another mode of treatment, which has smaller incisions and does not disrupt the normal strength of the abdominal wall too much. The principle of every repair is to pull back the prolapsed organ to its anatomic location and suture it to its supports, which are also strengthened in various ways.
The vaginal wall is also cut back to the required size so that it no longer bulges. The supports may be fashioned out of the woman’s fascia or may use synthetic mesh to repair the anterior and posterior vaginal walls. Autologous fascia has no risk of rejection but may provide lower objective measures of improvement. These measures are not always correlated with subjective or symptomatic relief, however.
Synthetic mesh, on the other hand, provides stronger and more durable support, but can and often does cause vaginal erosions, which may be painful. Its use has been cut back markedly as a result.
Biological grafts such as porcine grafts and absorbable meshes are therefore being studied as effective substitutes in the early healing stage, while avoiding the post-operative complications of synthetic mesh.
Mesh use still confers a superior anatomical outcome following the abdominal repair of pelvic organ prolapse. It leads to a lower incidence of dyspareunia following the procedure, but with increased operative and recovery duration.
If the prolapse is advanced in stage, hysterectomy is sometimes the best option, as in complete uterovaginal prolapse. However, women often want the uterus to be spared, and therefore more procedures to repair the vaginal vault without removing the uterus are becoming more popular. These may become more common still, because evidence shows that there is not much difference in functional outcomes whether the uterus is spared or not, as long as the vaginal fascia and pelvic ligaments are firmly attached.
Colpocleisis is a last-resort surgery that closes off the vagina permanently. It is useful in women who are very frail or very old, and cannot withstand the rigors of any longer procedure. It may also be advised if several previous operations have proved unsuccessful. It prevents future intercourse.Benefits of Surgical Repair
Surgical repair usually increases the quality of life. However, there is a risk of persistent symptomatology, or the symptoms may even worsen. For this reason, some surgeons prefer to repair the bladder supports at the time of prolapse repair, even if the woman has no stress incontinence. This may reduce the incidence of post-operative stress symptoms, but increases the operating time and the rate of complications.Complications of Prolapse Surgery
Complications of surgical repair include bleeding, infection, anesthetic complications, urinary infections, and sometimes urinary tract damage. Dyspareunia and recurrence may also occur.
http://www.news-medical.net/health/Treating-Pelvic-Organ-Prolapse.aspx
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Pelvic Organ Prolapse Prognosis
Jan 5, 2017 | News- Medical
By Liji Thomas
Prolapse of the pelvic organs is often distressing for affected women. However, many women do not experience any symptoms, and may not be aware of the condition until it is found during a routine pelvic examination.
Prolapse affects one in two women over the age of 50 years and has an overall prevalence of 30-50%. Women may expect to have an 11-12% chance of having to have surgical repair for prolapse, and one-third will need a repeat surgery.Symptoms
Symptomatic pelvic organ prolapse may present with a range of symptoms, such as:Pelvic pressure: The pelvic organs descend through the widened opening in the weakened pelvic floor, leading to a feeling of increased pressure in the pelvis.Pain: When pelvic pressure is more marked, the mass may compress adjacent nerves, causing leg pain or low backache. Sometimes the patient may complain of easy leg fatigue.Urinary symptoms: Incontinence, difficulty in initiating urination, and frequency may accompany descent of the urethra or bladder.Bowel symptoms: A woman who has a rectocele may experience difficulty with defecation because of the entrapment of stools in the outpouching formed by the rectum above the anal sphincter. This may cause abdominal, flank, or rectal pain, feeling of pressure, and constipation.Dyspareunia: Vaginal prolapse can cause mechanical interference with penetration, as well as irritation of the vaginal wall. This may lead to pain on intercourse as well. Finally, this may result in psychological stress and aversion to the act itself. Prognosis of Asymptomatic Prolapse
If women have no symptoms, they need take no special treatment for the prolapse. The only indication for treatment is if the condition is causing significant symptoms.Prognosis of Mild Grades of Prolapse
Women with mild to moderate prolapse, even without symptoms, may wish to avoid all factors that can increase the pressure on the pelvic muscles.
Lifestyle changes may include loss of weight for overweight women or quitting smoking for women who smoke. Constipation should be avoided as far as possible by including plenty of fresh fruits and vegetables in the diet, drinking enough water, and choosing whole grains. Meals should be regular and adequate for one’s energy consumption.
Women who routinely do heavy lifting, even at the gym, should abstain from it. Chronic cough or constipation should be treated appropriately.
Pelvic floor muscle training or Kegel’s exercises may be of benefit in relieving stress incontinence and hesitancy, symptoms which are typically associated with pelvic organ prolapse. This is most effective when taught individually, and in combination with the use of pessaries or with surgery, when indicated.
More major degrees of prolapse will not improve with pelvic floor muscle exercises alone. However, prolapse may keep from worsening with this training if consistently carried out.Prognosis of Major Prolapse
For those with significantly severe symptoms or whose symptoms cause major inconvenience, surgical intervention can produce a real improvement in their quality of life. If surgery is contraindicated for any reason, or if the woman is unwilling to undergo surgical repair, ring pessaries help to keep the pelvic organs in place in many cases.
Surgery for prolapse should be preceded by a thorough evaluation using a scoring system such as the POP-Q, which will reveal which areas require strengthening. Moreover, surgeons who are skilled in using more modern and less invasive techniques of pelvic reconstruction will usually produce better results.
Surgery may be performed vaginally or abdominally with equal effectiveness. Both these routes may be adapted to laparoscopic surgery, which reduces the total recovery time. Complications following surgery may include urinary infection, urinary incontinence, pelvic infection, bleeding from the site of surgery, and sometimes vaginal, rectal, or urinary fistulae. The use of mesh may produce vaginal erosions, which can lead to chronic irritation, dyspareunia, bleeding, and fibrosis.Recurrence
Recurrence of pelvic organ prolapse is a significant post-operative risk because it is difficult to strengthen the weakened pelvic tissues without using a permanent graft or mesh. The risk may be higher when cystocele surgery is done. The best correction rates are for a rectocele. Recurrence rates are least when the precipitating factors are avoided, and when pelvic floor muscle exercises are begun before the operation and continued regularly after the surgery.
http://www.news-medical.net/health/Pelvic-Organ-Prolapse-Prognosis.aspx
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