Dr. Goldman Talks Mesh Removals

Apr 4th, 2012 | By | Category: Medical News

Dr. Howard Goldman, Cleveland Clinic

A woman who I am planning to do a Patient Profile on called me the other day. She had surgical mesh partially removed at the Cleveland Clinic with urologist, Dr. Howard Goldman, two weeks ago. She was on her way back to the Cleveland Clinic in extreme pain. She had been on the same antibiotic for two years and now had a high white cell blood count, she said. This woman’ didn’t sound good and cried on the phone but she refused to go to an emergency room because, she said,  they didn’t know how to treat her.

I wanted to follow up with Dr. Goldman’s office to find out how he feels about partial mesh removals. Last week Dr. Goldman’s videos (here) featuring a partial mesh removal “excision”  and a mesh “incision,” where the mesh is cut to relieve tension, shown on YouTube, made their way to MDND and many readers complained believing that contributes to a worse outcome. While some doctors who advocate full mesh removal would agree, Dr. Goldman says that’s not his experience.

MDND: Are partial removals the answer for mesh removal?

Dr. Howard Goldman:  “We do removals specific to the area bothering the patient. Whether the mesh is extruded or exposed and is causing pain we remove what’s bothering her and we only try if it’s causing problem.

“As far as a total removal, I’ve seen patients ended up with major vascular or bowel issues and severe complications. If they have vaginal symptoms, we remove that portion and do not dig into their thigh. We do not want to make them worse.”

MDND: Do you not believe in the systemic response to mesh?

Dr. Goldman: “Mostly what we see are not systemic but localized symptoms. We have had a systemic response and we did go after more of it only in a specific situation. But if there is pain in an area or the mesh has eroded,  we take care of that and they feel fine.”

MDND: Women I’m hearing from are are devastated and debilitated with pain all over. Some go to see Dr. Shlomo Raz at UCLA who is seeing patients all over the world for mesh removals.

Dr. Goldman: “You may be seeing the tip of the iceberg, the ones who are devastated and debilitated.  In our paper which appears next month in the Journal of Urology, we looked at life after 20 odd vaginal mesh kits, and the vast majority had localized treatment and after three months and six months they did well.  I’m well aware of Dr. Shlomo Raz and his thoughts and I’m well aware he is a great surgeon.  I’m also aware that he’s a most vocal proponent of not using mesh. He was the most vocal proponent of using mesh.

“But we’re seeing a lot of women who have had more damage from the removal. People don’t realize the physicians have to have a lot of experience in this area.

MDND? What should you ask?

Dr. Goldman: How many have you done and completely taken out?

MDND: How many total removals do you do of the people who come in with complications?

Dr. Goldman: “We don’t have data but it’s not the majority, hardly any.”

MDND: Dr Donald Ostergard says mesh is not inert. See background story here. Do you agree?

Dr. Goldman: “It’s the same stuff that is used in vascular surgery; the same suture material. I can tell you among the slings, the vast majority are doing fine.”

MDND: How about the more mesh the more mess?

Dr. Goldman: “Were seeing a lot of technical issues –  some surgeons without good outcomes.

“There is a paper from a few years ago –  Ridgeway, B. is the first author, and in the new one the first author is Firoozi, F. Find it in PubMed to get the Abstract.

“The vast majority with localized treatment  at the three-month and six-month follow-up did well. I’ve seen your site and I’d like to think you are seeing the tip of the iceberg, not to discount that some women are in really bad shape with serious problems.”

MDND: Any idea of the complication rate?

Dr. Goldman: “We know from a number of studies the pain, erosion and extrusion rates when compared to no mesh. We do need more data.”  #

Learn More:

Journal of Urology, Purly Transvaginal/Perineal Management of Complications From Commercial Prolapse Kits Using a New Prostheses/Grafts Complication Classification System, March 14, 2012
http://www.ncbi.nlm.nih.gov/pubmed?term=goldman%2C%20h.%202012%20%26%20mesh%20kits

During the study period of November 2006-2010, 23 women were followed after having transvaginal mesh from prolapsed kits removed after experiencing complications. The average age was 61 and the median period of time until complications was 10 months. Complications included pain, extrusion, incontinence, prolapse, perforation and urinary tract infection, “Purely transvaginal mesh excision appears to be safe with resolution of almost all presenting symptoms.”

Editors Note: It’s unclear from this article whether or not the mesh removal was complete or arms and anchors were left behind. *

Dr. Donald Ostergard on Degradation, Infection and Heat on Polypropylene Mesh
http://meshmedicaldevicenewsdesk.com/removing-mesh-and-getting-healthy/dr-ostergard-on-degradation-infection-and-heat-effects-on-polypropylene-mesh/

International Urogynecology Journal, November 2010, Dr. Donald Ostergard
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3112322/?tool=pubmed

Articles on Tape Removal- PubMed
http://www.ncbi.nlm.nih.gov/pubmed?db=pubmed&cmd=link&linkname=pubmed_pubmed&uid=22453852

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24 Comments to “Dr. Goldman Talks Mesh Removals”

  1. Amy G says:

    Please find me these women that are perfectly satisfied following partial resection 1 year out-can’t seem to find any of them!

    • Jane Akre says:

      Yes Amy- we’re waiting to hear from them!! Women- where are you????

      • Mary says:

        I like to find these women also. He lure you in with his how to video. I went to him walking. He performed surgery on me I’ve had even more horrendous pain and infection I’m now on
        A cane !ll I’ll have my surgery soon with dr Raz soon. But now I’m really being treated for this horrible infection I’m fighting

  2. Lana Keeton says:

    Dr. Goldman should wash his mouth out with soap! His nose must be about 6 feet long by now. Unbelieveable that a doctor at a “reputable” hospital like Cleveland Clinic should perpetuate such a barbaric procedure by saying “hardly any, not the majority”. What kind of data is that? And to say “some surgeons without good outcomes”, who is he to make that judgment? What does he know about a foreign body polymers? Blaming other doctors without knowledge of the science behind mesh as a medical device is irresponsible.

    Lana Keeton
    President and Founder
    Truth in Medicine Incorporated
    http://www.truthinmedicine.us.com
    http://www.meddeviceexpertllc.com

    • Barb Lucas says:

      Dr. Goldman did surgery on mesh removal. He totally lied to my husband and I telling he removed all the mesh, and theres nothing else could be done. I still have the urethra sling totally in place and pieces of more mesh. Seems everytime I get a good reference for a doctor a few months later he gets on the bad list. I cant afford Californa or Texas. But wont go back to Goldman.

      • Greg Mack says:

        Barb,
        Saw your post and wanted to share this info. Dr Cohen or Dr Hibner are very good. If you have an attorney there is no out of pocket for the procedures, travel and accommodations. If you would like more information check out the web site or contact me directly by email.
        Thanks
        Greg Mack
        407-461-3200

        • rita says:

          where are these doctors located

        • iona douglas says:

          Hi Iona here , I do have a Lawyer and have been notified that my TVT Boston Scientific Atvan. had been Red Flagged by FDA..I have had 2 Surgeries and am Still having Pelvic Pain , 2nd Prolayps ETC..Lawyers cant give me any Medical Advise…NEED HELP PLEASE

  3. EH says:

    Yeah. I hear, and have read studies that say that. I know so many, and talk to them, that got worse after partial removal. I really believe that a partial removal affects the rest of the mesh. The force dynamics have to change – where once was tension, that has been removed. The pelvis is a very complicated part of the human anatomy, affect one part, and the rest of it responds. Put a “tension free” (what a crock – then how come it can be “too-tight”?) piece in this complex area and then expect it to stay in place. Movement has no effect at all? If you take a polypropylene ribbon, put it through a pillow in a loop and then cut it, what happen? The ribbon rebounds, no matter how small and even if you don’t move the pillow that much. How much more in the human body? I had a piece that hurt removed, and then it eroded into other areas. Several surgeries. It is very dangerous to just remove the one part of mesh. Ladies read, read, read and think. Many opinions out there. We’re guniea pigs. Better yet, skip this and use the old fashioned methods. P.S. I have another piece moving out about the size of a stitch. If you got a sliver, would your body keep it where it’s located – or try to move it back out? This is a foreign body. Sorry to rant, but this is so maddening!!!

  4. Handyman says:

    I am hoping to see this jerk when I go back to Cleveland soon. Got a few questions for him!!!! If anyone has to go to Cleveland please see Dr Mark Walters He will listen!

    • I had the mesh surgery about 6 yrs ago with Dr. Walters. Have had nothing but troubles….UTIs, burning and frequency…..went back a number of times and all he would say is everything is ok…and gave me anti-spasmatic and antibiotics. Will not go back to him……heard Dr. Raz is the best from UCLA…

      • Jane Akre says:

        Hi Rosemarie~ yes generally he is considered the most likely to have a successful full mesh removal..It is a procedure he has perfected to the degree it is possible,,We just keep horror stories about partial removals, sort of schrapnel left after a partial some say. I do not quite understand the disconnect between docs who do partials such as at the Cleveland Clinic and patient outcomes. Do patients not come back complaining? What do the docs say? Thanks for writing and there is a waiting list for Dr. Raz if you are interested in going to him. ~ jwarm regards, ja

  5. Kath says:

    A very unfortunate choice of words: “tip of the iceberg”. Although he’s using this expression incorrectly, I think this phrase actually hits the nail on the head – this problem really is many times larger underneath than it appears to be on the surface.

    To quote the freedictionary.com:
    tip of the iceberg
    n. pl. tips of the iceberg
    A small evident part or aspect of something largely hidden: eg. “afraid that these few reported cases of the disease might only be the tip of the iceberg.”

    The example given is so appropriate!

    Kath

  6. Kathleen says:

    My new friend went to ths Doctor and it was a disaster and she was so harmed by his partial removal. He promised her he could take some of the pain away. After the surgery she could barely walk, no longer work. After the surgery she developed a nasty infection she never had before. Not the level she had this time. He also was personally insulting to her. Told her that the smell (which she knew was infection) that she just needed to bathe more. She became bedridden over his help. He injured her all over again and now she must spend thousands of dollars to get proper medical care.

  7. Linda Dodson says:

    I wonder if Dr. Goldman would allow mesh put in his significant other’s pelvic floor area? VERY DOUBTFUL!!!!

  8. glenna hale says:

    I have been searching for a eurogynecologist to remove my mesh, but after reading all of your testimonies about Dr. Goldman, I don’t think I would even consider going to the Cleveland Clinic. I contacted Dr. Moore’s office in Atlanta GEORGIA, and am waiting for a consultation with him. I hope to have the entire mesh removed if possible, because I have had too many medical complications arise after my 2009 implant, up to and including becoming disabled to work in July of 2009. I cannot even get any of the local doctors where I live to acknowledge that I am having mesh complications, up to and including the doctor that implanted it. I do know that if the doctor would have informed me of any possible complications, I would not have had this surgery done, and I definitely do not recommend this type of surgery to anybody that may be considering it for the future.

    • Jane Akre says:

      Glenna-

      I’m so sorry to hear about your problem. Unfortunately it is not unusual. First the doctors put in the mesh. Patients either didn’t hear about the complications or they weren’t told. When they have problems, no one knows how many do, the doctor says “you’re the only one” and she walks away like there is something wrong with her. she is told to wait- it will get better. When it doesn’t she again feels like it’s her fault. Then the doctor, who doesn’t know what to do, sends her to pain management.

      In what universe is this an appropriate outcome for a simple “minimally invasive” procedure?

      • glenna hale says:

        The doctor did not explain how this procedure was done. For a long time, I didn’t know that he had implanted a mesh. In May of 2009 I started experiencing various medical conditions from my entire body aching, respitory/breathing problems, pain in my thighs that felt like it was in the femur bones, pain around my knee caps, and I began to walk with a limp. I dindn’t figure it out until I started seeing ads about mesh complications on TV. Then I started looking mesh complications up on the internet, and I found out sometime in 2010 that I had a gynecare tvt implanted. Then it all started to add up. Prior to surgery I had none of the complications that I came down with after surgery.

  9. Sam says:

    Are these woman seeking legal help? We used a great attorney for my friends moms case, which I would be happy to refer to those needed. You can call me 310-980-9416 or email me at salarh@gmail.com

  10. meemers says:

    Dr. Mark Walters is who handled my mesh removal, Dr. Goldman repaired my urethra, So far I am happy with the results, though I am still in the healing phase. Dr. Walters has been fantastic, so please do not hesitate if you need someone in the Cleveland area!

  11. Bob says:

    Please women! Pay attention. .These guys will put this mesh into you because you let them..wake up!! If your ‘surgeon’ can’t do the correction the old fashioned non destructive way..GET ANOTHER SURGEON!
    These as Sholes will ruin you and your marriage. .they get 25k
    to put it in and 50k to Butcher you and take it out!
    Wake up!

  12. Annie says:

    What Dr. Can I get in Ohio ,Cleveland because I have problems. I am 67 . Thank you for you time.

  13. michelle says:

    Just wanted to say…I consulted via email with both Dr Raz and his colleague, Dr Kim, regarding my sub-urethral sling that was eroding and causing bladder, vaginal and urethral pain. Because I have NOT had any groin or leg pain, both of them recommended a partial removal and advised the risk involved by trying to remove the meds that are embedded in the obturator muscle would be better avoided. I only am telling you this because it seems as though everyone considers Dr Raz the final word in mesh removal, yet his advice is apparently not always fir complete mesh removal. Proceed with caution by all means, but I think dismissing competent surgeons based solely on the belief that only complete removal is acceptable may be a mistake.

    • Jane Akre says:

      Thank you very much Michelle for this insight from Dr. Raz and Dr. Kim. They are perhaps the most experienced removal surgeons in the world. Thank you for sharing.~ ja

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We hope you find this a helpful resource. National News Editor, Jane Akre, began MDND with the hope of providing the latest news, information and perspective from the regulatory, industry and patient point of view, something that goes under-reported in much of the coverage of medical devices. The public is just now becoming aware that many devices do not undergo the same scrutiny as prescription drugs and are instead grandfathered in under an FDA loophole that has gone largely unchanged since the 1970s. As a result, patients become the post-market clinical trial subjects, and many suffer devastating and permanent injuries.