Aversion to mesh use for pelvic floor surgery in a latina population at the U.S.-mexico border

Abstract

The objective of this study was to characterize the perspectives of a sample of Latina women on the U.S.-Mexico border regarding mesh use in pelvic surgery for urinary incontinence and pelvic organ prolapse. Additionally, we sought to determine factors associated with level of concern with, or aversion to, future mesh surgery. This was a cross-sectional study of self-identified Latina women with symptoms of pelvic floor disorders, recruited at their initial visit, at a single academic Urogynecology clinic. Subjects completed a validated survey assessing perceptions of mesh use in pelvic surgery in English or Spanish. They completed validated questionnaires assessing presence and severity of pelvic floor disorders and items on the Short Acculturation Scale for Hispanics (SASH). A chart review collected participant history and characteristics. Primary outcomes were level of concern regarding possible future mesh surgery and aversion to future surgery. Descriptive analysis, univariate relative risk, and linear regression analyses were completed. A p-value of <0.05 was considered statistically significant. Ninety-six women were included in the primary outcome analysis. Average age of participants was 54.5 years. Approximately 60% had symptoms of prolapse (stage 1 26.7%, stage 2 45.6%, stage 3 6.7%), 64% had a negative cough stress test, and 6.3% had prior pelvic floor surgery utilizing mesh. About 66% of participants indicated they would be likely to avoid pelvic surgery utilizing mesh. Prior hysterectomy was more prevalent among participants who would avoid mesh surgery (50.8% versus 27.3%, p 0.03). Only 9.4% obtained information regarding mesh directly from medical professionals. Level of concern regarding the use of mesh varied widely (29.2% not worried, 19.1% somewhat worried, 16.9% very worried). There were no significant differences in the median summary scores for the PFDI-20 (median score 39.6 vs 32.9, p 0.08) or PFIQ-7 surveys (median score 57.1 vs 61.8, p 0.43) among participants who would or would not avoid mesh surgery. Median SASH scores were significantly higher in participants likely to avoid mesh surgery (3.0 vs 2.0, p 0.01), coinciding with higher percentages of acculturation in this group compared to participants who would not avoid mesh surgery (“more acculturated” 58.7% vs 27.3%, p <0.05). This result remained the only statistically significant finding on regression analysis. In this Latina cohort, we found a large proportion of patients indicated an aversion to the use of mesh in pelvic surgery. This decision appeared to be significantly influenced by their level of acculturation. Few patients reported obtaining information regarding mesh directly from medical professionals. Future studies can identify methods of increasing patient education regarding the use of mesh and to dispel myths or misconceptions in our patient population.