In my opinion, the top story of 2014 is the ongoing medical–legal dynamic around mesh for the indications of stress urinary incontinence and pelvic organ prolapse in women. The impact of this litigation is a topic not only of the lay media but also now a daily discussion point with patients regarding both their risks associated with undergoing any procedure utilizing mesh and also the inherent problems that they may experience due to previously placed mesh.

The importance of this litigation is that it is clearly impacting clinical practice (many technicians now are not familiar with non–mesh based procedures) and also has significantly affected clinical decision-making related to patient informed consent as well as to type and performance of procedure. Equally importantly is the misinformation that some patients have garnered from media and Internet reporting related to potential mesh causation of pathologic phenomenon including malignancy as well as autoimmune issues.

This story is critical because it impacts not only urology but also private obstetrics and gynecology and primary care physicians, as they are the providers who commonly see these patients both pre- and postoperatively and who are prone to be asked substantive questions about preoperative risks as well as address post-implantation concerns that these patients may develop.

Detrimental outcomes after an implantation include not only lack of intended efficacy but also mesh erosion, exposure, dyspareunia, and substantive pain. The referenced article details at length the results of mesh excision and associated pain and should be standard reading for urogynecologists, obstetricians and gynecologists, and primary care physicians.¹