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The factor or factors responsible for the change in practice patterns over years in surgery, and more specifically, Female Pelvic Medicine and Reconstructive Surgery, are likely numerous and varied. Although it is interesting to speculate that the major reason for these changes is that surgeons have “heeded” the Food and Drug Administration (FDA) warnings, regulatory changes, such as the FDA Public Health Notification (PHN), are but one potential etiology. It was only 2 decades ago that the most commonly performed procedures for the correction of female stress urinary incontinence were needle bladder neck suspensions such as the Raz and Stamey procedures. New technologies, better approaches, better efficacy and safety, shorter recovery, and cheaper cost are examples of other drivers of change in our field. Although it is convenient to attribute the changes in practice patterns across the 8 academic medical centers to the FDA PHN, or even physician acknowledgment of such measures, we caution that there may be many other factors. As noted in the paper, we did not sample community urology practice where such changes may or may not be present. Importantly, the FDA PHN has coincided with, and some may speculate that it has resulted in, a flurry of medico-legal activity surrounding vaginal mesh procedures. True or untrue, deserved or not, widespread advertisements promoting plaintiff activities against mesh across all media outlets including print, television, and the internet likely create an atmosphere of misinformation, apprehension and fear among our patients. 1 Koski M.E. Chamberlain J. Rosoff J. et al. Patient perception of transvaginal mesh and the media. Urology. 2014; 84: 575-582 Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar , 2 Brown L.K. Fenner D.E. Berger M.B. et al. Defining patients' knowledge and perceptions of vaginal mesh surgery. Female Pelvic Med Reconstr Surg. 2013; 19: 282-287 Crossref PubMed Scopus (32) Google Scholar , 3 Tenggardjaja C.F. Moore C.K. Vasavada S.P. Li J. Goldman H.B. Evaluation of patients' perceptions of mesh usage in female pelvic medicine and reconstructive surgery. Urology. 2015; 85: 326-331 Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar Within the confines of patient autonomy, this, too, may be an important factor in the changing practice patterns among practitioners as our patients question the safety of mesh based on their own interpretation of such media activities. Ultimately, however, whatever their underpinnings, patient, physician, or regulatory, the changes in practice patterns in the realm of pelvic floor reconstruction are very real and appear to be durable in the foreseeable future.