Because of their close proximity to the uterus, tubes, ovaries and vagina, injuries to the bladder, bowel and ureter are not uncommon in gynecologic and obstetric surgeries. The incidence of injury to these adjacent organs can run as high as 2.5%.
Other complications include but are not limited to infections, pelvic pain, adhesions, dyspareunia (painful intercourse), and vulvar/vaginal disfigurement after vaginal surgery.
The diagnosis, management and correction of these injuries require advanced subspecialty training and experience. Dr. Margolis’ particular expertise is in the repair and correction of these complications and has served as consultant surgeon for doctors and patients worldwide. He has enjoyed an excellent success rate in correcting complications and restoring normal anatomy and function.
One new area of particular concern is the unique problem of sling and mesh complications.
In 1998, medical device companies first introduced synthetic mesh for use in the correction of stress urinary incontinence and pelvic organ prolapse. Whereas the use of mesh initially enjoyed popular support among general practitioners Dr. Margolis has maintained from the beginning that the synthetic mesh systems used for transvaginal surgery were dangerous, defective and should not be used.
At first, he was one of the only doctors to speak out against these systems then the journals started reporting the complications Dr. Margolis feared would be seen. Such complications include (among other injuries) mesh erosions, obstruction of the urethra, chronic urinary tract infection, injuries to bowel, injuries to the bladder, injuries to blood vessels with massive hemorrhage, injuries to nerves, urethral obstruction, fistula to the bladder and bowel, mesh infections, pain scarring, loss of sexual function and disfigurement of the vulva and vagina and unfortunately death. Furthermore, these procedures have a lower success rate than standard operative procedures.
A recent multicenter prospective trial of mesh vs. standard technique was halted do to complication rates well in excess of all accepted standards*(click to read trial). The most impressive publication, however, was the landmark “Black Box Warning” from the FDA in October, 2008. Review of the MAUDE data base by the FDA led them to take the unprecedented action of placing a warning to physicians about the high complication rate associated with mesh for incontinence and prolapse.
To date, Dr. Margolis has removed or reoperated on over 100 women with sling and mesh complications making his experience one of the most extensive in the U.S. Experience has taught him valuable lessons on the approach most suitable to the women suffering from sling/mesh complications. Use of biologic materials such as Cook Surgisis has significantly aided healing in his experience. Dr. Margolis continues to treat women with mesh complications and advocate for removal of all defective products from the market.