Female Urology Patient Perception of Transvaginal Mesh and the Media Michelle Elaine Koski, Jennifer Chamberlain, James Rosoff, Taylor Vaughan, Melissa R. Kaufman, Jack C. Winters, and Eric S. Rovner OBJECTIVE To assess the penetration of media-based information on transvaginal mesh (TVM) in our patient population and to determine whether exposure affects patient opinion. Since the 2011 Federal Drug Administration communication on TVM, many advertisements from legal practices have been directed toward patients. MATERIALS AND METHODS An 18-item survey was administered to female patients at 2 sites from August 2012 to April 2013. Patients presenting with new diagnoses of pelvic organ prolapse or stress urinary incontinence or patients who reported prior mesh surgery were excluded. RESULTS Ninety-nine questionnaires were completed. Sixty-six of the patients (67%) were aware of TVM; and of these, 38 (58%) cited advertisements as the initial source of information. Only 12% were aware of the Food and Drug Administration’s communication. Regarding opinion of TVM, 9% chose “it is a safe product,” 9% “safety depends on factors related to patient,” 4.5% “not a safe product,” 1.5% “safety depends on the doctor,” 68% “I don’t know,” and 4.5% marked 2 selections. Only 12% indicated knowing the difference in the use of TVM for pelvic organ prolapse vs stress urinary incontinence. When asked what influenced their opinion of TVM the most; responses were as follows: advertisement (33.3%), medical professional (22.7%), friends or family who underwent TVM procedure (12.1%), media article (6.1%), and “not sure” (25.8%). CONCLUSION Advertisements of TVM lawsuits had a high penetration into our patient population but did not produce an overtly negative response in our sample. Clinicians should be aware of the impact of these advertisements on patient opinion and counsel patients accordingly with unbiased and scientifically accurate information. UROLOGY 84: 575e582, 2014. Ó 2014 Elsevier Inc. S ince the July 2011 Food and Drug Administration (FDA) safety communication regarding trans- vaginal mesh (TVM), 1 there has been a prolifer- ation of media information from nonmedical entities directed at patients. Some articles in the lay literature have conveyed potentially misleading information. 2-4 Advertisements are being widely used to recruit plain- tiffs for mesh litigation. Some advertisements use in- flammatory language and imaging, whereas others contain information that is false or misleading. One example states that mesh is “no longer recommended in America” and mentions cases of “mesh disintegrating . and flow- ing throughout the body and becoming embedded.” 5 No supporting evidence is provided by these claims, and literature review reveals no supporting documented cases. Within the field of female pelvic medicine, the exact role of mesh for pelvic organ prolapse (POP) remains controversial. 6,7 However, even as this is debated among experts in the field, it does appear that many patients continue to benefit from its use when used selectively and properly implanted. 8,9 Clinicians have encountered patients with heightened concern regarding the mesh. For example, it is currently not uncommon for patients several years out from a TVM procedure with no complications or symptoms to present questioning whether their mesh should be removed. Although there is a high value in patient awareness of these issues as well as in discussion between patients and physicians, information disseminated in a nonmedical environment and outside of the proper context could result in unnecessary patient anxiety or fear. Such experiences led us to inquire whether patients are able to find reliable unbiased sources of information regarding TVM in the current media environment. Herein presented are the results of a novel, prospective, Financial Disclosure: M.R.K. is a principal investigator in a study supported by Cook Medical and is a meeting participant at Astellas Pharma US and Allergan. J.C.W. is a member of the advisory board at Allergan. M.E.K. is a meeting participant at American Medical Systems. E.S.R. is an investigator in a trial supported by Ion Innovations, an investigator in a trial supported by Targacept, and an advisor with Ferring, TARIS Biomedical, and Amphora. The remaining authors declare that they have no relevant financial interests. From the Department of Urology, Medical University of South Carolina, Charleston, SC; the Department of Urology, Louisiana State University Health Sciences Center, New Orleans, LA; the Department of Urology, Yale University, New Haven, CT; and the Vanderbilt University Medical Center, Nashville, TN Reprint requests: Michelle Elaine Koski, M.D., Department of Urology, Kaiser Permanente, San Diego, 5893 Copley Drive, San Diego, CA 92111. E-mail: mkoski82@hotmail.com Submitted: February 11, 2014, accepted (with revisions): March 18, 2014 ª 2014 Elsevier Inc. All Rights Reserved http://dx.doi.org/10.1016/j.urology.2014.03.051 0090-4295/14 575