Analysis

What you need to know about vaginal mesh surgery

Women are experiencing life-changing complications from vaginal mesh surgery, the use of which is now under review

Women are experiencing life-changing complications from vaginal mesh surgery, the use of which is now under review

Many nurses ‘do not know anything’ about complications from vaginal mesh surgery and need education and training to help those who have experienced adverse effects.


Campaigners from the Sling the Mesh campaign supported by Owen Smith MP. Picture: Alamy

This warning comes from campaigners and experts after the government announced a temporary ban on the controversial devices.

Labour MP for Ealing Central and Acton Rupa Huq has called transvaginal mesh tape (TVT) implants ‘the biggest medical scandal since thalidomide’ and researchers have said 10% of women who have been fitted with it may experience life-changing complications.

1 in 15

women who have had vaginal mesh surgery have since had it partially or fully removed

Source: The Guardian 

Considered a routine NHS day case procedure, mesh surgery is used to treat stress urinary incontinence (SUI) and pelvic organ prolapse (POP), issues that can occur after childbirth.

TVT is used as an alternative for more invasive surgery and has been offered as the ‘better option’ by the medical industry.

NHS Digital data shows that more than 100,000 women have been given the mesh implants for SUI in England in the last decade (2008-17).

But the mesh devices have now been linked to life-changing injuries, chronic pain and even death, and hundreds of British women have joined thousands worldwide who are taking legal action against mesh manufacturers.

Banned

In July, the government accepted a recommendation to temporarily ban vaginal mesh implants for women with SUI. This also follows National Institute for Health and Care Excellence (NICE) guidelines that recommended last December that mesh should no longer be used to treat POP.

The Independent Medicines and Medical Devices Safety Review is currently looking into the many cases in the UK where women have had adverse effects from mesh implants and will soon issue a call for evidence.


Baroness Julia Cumberlege is
chairing the review of vaginal mesh
surgery. Picture: Neil O' Connor

Baroness Julia Cumberlege, chair of the review, said the government’s suspension of the use of mesh implants should last until March 2019, when conditions to mitigate the risk of injury could be put in place.

In a statement, Baroness Cumberlege said: ‘We strongly believe that mesh must not be used to treat women with SUI until we can manage the risk of complications more effectively.

‘We have not seen evidence that the benefits of mesh outweigh the severity of human suffering caused by mesh complications.

‘I have been appalled at the seriousness and scale of the tragic stories we have heard from women and their families. We have heard from many women who are suffering terribly.

‘Their bravery and dignity in speaking out is deeply moving, and their sadness, anger, pain and frustration at what has happened to them and others has been compelling. We had to act now.’

Lack of understanding

Women who experience complications from the mesh surgery report a lack of understanding from nurses and doctors – even those working in urology or gynaecology specialties – and say their problems are often dismissed.

Health issues that have been linked to vaginal mesh surgery include: 

  • Fibromyalgia and auto-immune issues.
  • Chronic and severe pain.
  • Mesh cutting through or pressing into vaginal tissue and nerves, leaving women unable to walk or have sex. 
  • Ongoing debilitating urinary problems and infections.
  • Antibiotic resistance.
  • Anxiety and depression.

UK campaign group Sling the Mesh is increasing awareness of mesh implant surgery and has more than 6,500 members.


Dawn Martin, nurse practitioner 

Founder Kath Sansom says: ‘Many members say when they go to the GP, A&E or have an overnight stay in hospital due to a chronic urinary tract infection (UTI), or have gone into retention or they are in unbearable pain, many nurses don’t know anything about mesh complications.

‘It is paramount that nurses try to understand what the issues are because it is bad enough for women to suffer so terribly, but to then meet healthcare professionals who know nothing about it is very upsetting.

‘A survey of 540 women on our support network has shown that eight out of ten of our members suffer pain so badly they struggle to walk or sit, more than half have ongoing UTIs and a worrying 12% of those are becoming resistant to antibiotics.’

'Catastrophic complications'

Ms Sansom adds that a further 2% have lost their bladder or bowel and seven out of ten have lost their sex life.

She says: ‘The complications are catastrophic and a personal tragedy for each woman involved.

‘The overwhelming complication women struggle with every day is unbearable pain where the plastic mesh can shrink, twist, go brittle and cut or press into nerves or tissue in one of the most sensitive areas of a woman’s body.

‘If nurses understand how difficult it is to live with that level of pain, so they can be sympathetic to women’s suffering, it would go a long way to help women feel supported.’

Alternatives

Ms Sansom also says there are alternatives to TVT women should be made aware of, such as: physiotherapy, repair using a woman's own tissue, known as native tissue slings, or a Burch colposuspension for SUI, an operation to lift the neck of the bladder.


Amanda Cheesley: 'Training needs
to be in place.' Picture: John Houlihan

RCN professional lead for long-term conditions Amanda Cheesley says generalist nurses need better general knowledge about SUI and the issues around vaginal mesh surgery.

‘Training and education needs to be in place, both for preregistration and postregistration nurses, because this is not just a “specialist” topic.’

Ms Cheesley says one of the ‘huge issues’ to contend with is that continence itself has not been seen as important.

Overhaul of attitudes

‘Lots of people don’t think it is important, that it is something to do with age or having a baby – but it is a major issue for some people.’

She also says that there needs to be an overhaul of some attitudes in the nursing and medical professions that have led to patients’ symptoms being dismissed.

‘A person knows what their body is telling them, but too often health professionals are unaware of, or underestimate, the impact that vaginal mesh surgery can have on some people.

‘It is a significant problem and it has been under-reported.’

100,516

Women who had a surgical mesh procedure for stress urinary incontinence between 2008 and 2017 in England

Source: NHS Digital 

Portsmouth nurse practitioner in general practice Dawn Martin says many women experiencing mesh complications need nurses and GPs to give them some support and time.

‘All they really want is someone to listen to them and not be fobbed off, to have someone sit with them and give them a bit more time.’

Ms Martin herself had the TVT operation in 2014 and describes it as the worst decision of her life.

Intense pain

She says she suffered intense pain, skin rashes, wheezing, rhinitis, thrombophlebitis, worsening of pre-existing asthma and extreme fatigue – and three months later, she was back on the operating table to have the mesh cut.

‘The cocktail of opiate drugs given to me to control the pain caused an anaphylactic-type reaction and subsequent respiratory arrest, which left me in the intensive care unit.

‘I live with the regret that I put myself in for an operation to cure SUI and have ended up with no quality of life.’

As a nurse practitioner, Ms Martin also says she is finding more women presenting with recurrent health issues such as UTIs, and when she investigates it, she finds they have had TVT.

‘Every day of the week, I come across somebody new with recurrent issues. I look back at their notes and wonder what else could be causing this.'

'Tip of the iceberg'

West Midlands practice nurse Angela Peace, who has undergone eight years of 'pain, loss of movement and recurrent UTIs' since having TVT surgery, says she is worried that the number of women now coming forward with complications related to the surgery is 'the tip of the iceberg'.

Ms Peace says polypropylene – the same material used to make some plastic bottles is also used to make the mesh device – was not designed to be put inside human bodies.

'It could be ten or 15 years down the line that women have problems – it's a ticking time bomb.'

'Criminal'

On a personal level, Ms Peace says her ongoing TVT experience has been severely painful 'and mortifying', and she feels let down by nurses and doctors who she thinks have not taken her health issues seriously.

'I have felt so often like a complete freak.

'It is criminal – staggering – when I have told people what is going on, no one has recognised what I am saying. Health professionals need to be aware of these problems.'

The British Pain Society president and anaesthetist Andrew Baranowski has been running a chronic pelvic pain clinic for 25 years.

2019  

National Institute for Health and Care Excellence guidelines are due on the use of vaginal mesh for stress urinary incontinence

Dr Baranowski says: ‘Living with chronic pelvic pain is associated with a significant negative effect on mood, thoughts, behaviour, sexual and personal relations as well as employment.

Anxiety and depression

‘It increases the risk of depression and anxiety and is associated with increased suicide risk as well as mortality from other conditions like cardiac problems.’

Ms Cheesely is now leading a project at the RCN to develop a master's level module in the management of bladder and bowel problems which will run from next year.

In the meantime, she says that understanding issues about incontinence and the current problems with TVT are vital for nurses.

'It is everybody's responsibility.' 

Use of vaginal mesh implants in the four UK countries  

England In July 2018, NHS England said the use of mesh implants will be 'paused' until strict new conditions are met, but will remain a last-resort treatment for some patients. Baroness Julia Cumberlege, who is chairing a review into vaginal mesh, says the review team was in no doubt the pause was necessary, saying: 'We must stop exposing women to the risk of life-changing and life-threatening injuries.' 

Northern Ireland In July 2018, the country's chief medical officer Michael McBride wrote to all health and social care organisations to instigate a pause in the use of surgical mesh to treat stress urinary incontinence and for urogynaecological prolapse until at least March 2019, following England's decision, saying: 'All cases should be postponed if clinically appropriate and safe to do so.' 

Wales In July 2018, cabinet secretary for health and social services Vaughan Gething announces that, in line with England's decision to suspend the use of mesh, a pause in the use of mesh should also occur in Wales. He says: 'It is my expectation that these additional restrictions will be the case until the requirements for increased safeguards can be met.   

Scotland In August 2018, a parliamentary report called for a complete ban on mesh implants. In 2014, health secretary Alex Neill asked Scotland's health boards to suspend the use of mesh while an independent review was carried out, but about 500 women have had the procedure since then. Criticism of that review has led to a government review of the independent review in 2017, which is ongoing.


Further information

Free counselling helpline

A counselling service has been set up for the duration of the safety review for people affected by vaginal mesh surgery.

The line is open 8am to 6pm Monday to Friday. 0121 314 7075

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