Vaginal Mesh Implants
Sometimes referred to as a ‘sling implant’ or ‘tape’, it is a treatment to help permanently fix pelvic organ prolapse and stress urinary incontinence.
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These conditions may affect women after they have had hysterectomies, menopause or childbirth.
Doctors recommend vaginal mesh surgery usually if other treatments (such as pelvic floor exercises) are unsuccessful.
The surgical mesh is usually made of plastic called polypropylene (the same material is used to make particular drink bottles). The material is able to shrink, twist, degrade and can even cut/erode into nearby tissues and organs.
In these procedures, doctors implant the mesh via a simple operation; this is where the vagina is opened at the vaginal wall and the mesh is secured in place. Inserting the mesh this way is far quicker, easier and less invasive. The procedure allows the angle between the urethra and the bladder to form a better shape, resulting in the woman becoming continent again. The mesh becomes embedded in the surrounding tissue and is designed to be permanently fitted.
There are four different types of transvaginal mesh that are used; they are categorised by the types of material and how the material reacts inside the body.
- Non-Absorbable synthetic – This is a permanent implant that has the intention of staying in the body indefinitely. More than half of all mesh products approved by the Food and Drug Association fall into this category. These are the types of mesh which are made from synthetic materials, such as plastic or polyester. Roughly 90% of non-absorbable synthetic mesh is made of polypropylene.
- Absorbable synthetic – A short-term treatment where the mesh loses strength and eventually degrades over time. As the mesh is absorbed by the body, tissue grows at the implant site, thus helps strengthen the ligaments in the pelvis.
- Biologic – Natural products which derive from animal tissue that has been disinfected. These products also degrade over time and are usually made from cow (bovine) or pig (porcine) tissue.
- Composite – Composite mesh is made from a combination of non-absorbable synthetic, absorbable synthetic or biologic mesh.
Who receives vaginal mesh implants?
Studies suggest that the majority of women who receive the treatment are usually over the age of 50. This is mainly because weak tissue or ligaments around pelvic organs can be restored in younger women through lifestyle changes and pelvic floor exercises.
It also mainly includes women who have had several children (or even just one child), are most likely overweight, have had a vaginal tear or didn’t exercise at all during pregnancy or after having a baby. However, the risk of pelvic floor prolapse and associated incontinence can be increased with having a particularly difficult childbirth (especially long labour) and long-term coughing, such as if you are a smoker.
What are the complications from the surgery?
Hundreds of women have been left in permanent pain from having the surgery, leaving them unable to even walk, let alone do simple everyday tasks, e.g. going to work, household jobs and looking after their families.
One of the main, most severe, causes is where the mesh erodes and/or breaks down into smaller pieces, resulting in organ perforation. As the area being stitched up is a weak point of the vaginal wall, it allows the mesh to find that weak point and can protrude outside the vagina. Sometimes the mesh has been so near the nerve it could not be fully removed through surgery, which has resulted in some women suffering from nerve damage. These sorts of severe complications usually require surgery to fix. Synthetic surgical mesh is designed to permanently stay in the body; therefore removal of the mesh is particularly difficult. This is because blood vessels and tissue grows around the mesh, requiring doctors to remove it in pieces, one surgery at a time.
Other complications can include infection, bleeding and the strain of future pregnancies may also cause the prolapse to recur.
The typical type of patient suffering from mesh implants are usually incapacitated due to severe chronic pain. They can become so incapacitated that many women are either walking with crutches for support or are reliant on wheelchairs.
Additionally, some women have noticed that the mesh has begunn to erode when they or their partners have felt discomfort or have been injured during sex.
However, women who have successfully recovered from the procedure have resumed their normal everyday activities within a couple of months of the operation. The surgery should only result in minor pain or discomfort for a few days after the operation. Nevertheless, recent statistics have proved that many women receive far worse than the normal expected level of pain.
Between April 2007 and March 2015, more than 92,000 women had vaginal mesh implants in England, according to NHS data from the Hospital Episodes Statistics, obtained by the Victoria Derbyshire programme.
According to data, around 1 in 11 women have experienced problems and in the past decade about 1 in 15 of all women who received the procedure have had the mesh partially or fully removed.
In 2011, the Food and Drugs Administration (FDA) reported that it had received 4000 reports of complications related to transvaginal mesh during the past 6 years.
There are currently around 100 types of vaginal mesh implants available in the UK. So far, not one model has been recalled in the UK.
Currently, more than 800 women in the UK are taking legal action against the NHS and manufacturers (including US pharmaceutical giant Johnson & Johnson, who are the biggest manufacturers of mesh implants).
In accordance with the guidelines, manufacturers only have to provide documents that show their vaginal mesh implant is similar to one already on the market and it is highly likely to be approved. One leaked email from Johnson & Johnson suggested it had known problems existed with one of its products since 2004 however they were still accepted to be sold and used in surgical procedures.
All 100 types of mesh products are still on the market and are still being prescribed on the NHS across the UK, even though a recent review in Scotland said they should not be routinely used for pelvic organ prolapse.
Research carried out by medics at Leicester, Newcastle and Ireland says surgeons are more likely to give women mesh implants because they don’t have the skills to do the tried and tested old fashioned/traditional repairs known as ‘Burch’ or ‘autologous slings’.
Sling the Mesh Campaign
Sling the Mesh Campaign is headed by regional newspaper journalist Kath Sansom, who had the mesh implant operation on the NHS, to fix problems caused by childbirth.
Following the 20 minute operation, she was in agony with pains in her legs, feet and groin, which left her struggling to walk far. She was unable to use tampons due to severe internal burning and spasms caused by the plastic mesh.
She has since had the mesh implant removed by a specialist surgeon. Within a week the burning and spasms disappeared, alongside most of the leg and foot pain.
Kate launched the campaign 10 weeks after operation and is calling for:
- A full investigation and audit to be carried out into how many women have been adversely affected by vaginal mesh implants and tapes. They want the NHS to write to every woman who has had the operation.
- Until that review is complete and they have a full picture of the scale of the disaster they demand that mesh implants are suspended.
- A National Register for mesh implants so a woman is tracked for her lifetime.
- Bring forward the NICE guidelines for mesh for incontinence. The next review is not due until 2019.
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