What is the Problem with Mesh Implants for Incontinence?

Vaginal mesh implants for incontinence have been a popular phenomenon across Europe and in the US since the early 2000s. However, problems surrounding mesh implants is a topic that seems to resurface countless times.

A mesh implant has even started to become favoured over traditional procedures. However, a recent NHS review has found that hundreds of women are now having their implants removed after complaining of severe complications. The Guardian revealed last year that the number could be even higher than the recent figures for complication rates suggested. British Politian Baroness Cumberlege explained that the government found no evidence on the benefits for treating urinary incontinence that would outweigh “the severity of human suffering caused by mesh complications”. As a result, the NHS is now putting a cap on mesh operations to prevent long term consequences. This decision comes after the health watchdog NICE has recommended that vaginal mesh operations for treating prolapse should be stopped in England. This will not, however, serve as a complete ban for everyone. England’s Chief Medical Officer, Sally Davies explains “carefully selected patients will continue to have access in discussion with their consultant. A number of Scottish health boards have already stopped using mesh implants, and in Wales the procedures are currently seen only as a last resort for those who have no other option. Julie Cumberlege, the NHS review;s chair, explains “I am appalled at the seriousness and scale of the tragic stories” that her team has found.

What are Vaginal Mesh Implants?

The name doesn’t sound very pleasant. “Vaginal mesh” can sound like a scary, dystopian procedure. However, a vaginal mesh is purely a synthetic net material used in the placement of a weak connective tissue or ligaments, suspending the vagina and uterus. The vaginal mesh is implanted in a simple operation where the vagina is opened at the wall and the mesh is then secured in place. The angle between the urethra and the bladder is therefore in better shape, allowing the woman to control urination.

Mesh implants are used for urogynecologic procedures, including repair of pelvic organ prolapse and stress incontinence. This means these women suffer from leakages when their bladder is put under pressure, during activities such as laughing or coughing. The majority of women who receive the treatment are over the age of 50, however younger women can also receive the treatment. It is often suitable for women who have had several children, are overweight or never did any exercise during pregnancy.

What are the Complications?

Problems after the surgery are usually caused by the mesh eroding and being broken down into smaller pieces. Dr Ismail explains, “the vagina area being stitched up is a weak point of the vaginal wall. The mesh is often able to find its own way through this weak point and protrude outside the vagina”. Common complaints due to this problem have included sexual problems, mesh exposure through vaginal tissues and injury to nearby organs, such as the bladder or bowel. In the worst-case scenarios, women complained of being unable to even walk without being in pain. Kate Langley is one of the victims who was forced to give up her business as a childminder because the pain was so intense she couldn’t look after the children. She explains how the surgeon who first examined her could “see the mesh tape had come through the vagina, protruding through. The mesh had cut its way through, like a cheese-wire”. She claims mesh implants to be “barbaric” and has been left in permanent pain, as the mesh was so near the nerve it could not be removed.

Over the past decade, there were 5,374 mesh removal operations in women who had initially been treated for stress incontinence. The large number of implant removal procedures has shocked many health experts, with many wondering why the surgery was previously allowed. Dr Heneghan claims, “twenty years after the first device was approved, we’re only just starting to get to grips with the evidence base. That means there’s been experimentation for 20 years”. Health experts are currently looking for an alternative to the mesh material that has put so many women in pain. Scientists from the University of Sheffield for example, have recently found a softer and more elastic material that they believe will be safer for the pelvic floor muscles. Lead author Sheila MacNei, professor of tissue engineering at the University, claims “for many years now surgeons have been treating the problems of urinary stress incontinence and pelvic organ prolapse using the only synthetic material they had to hand-polypropylene”. Following the shocking reports of complications, it is hoped that there will be a suitable alternative as soon as possible.

Mesh Implants and the NHS

In April 2019, new guidance on mesh implants was published by National Institute of Clinical Excellence (NICE). The guidelines stated that mesh implants can be used only if the patient is aware of the risks. However, this has been met with opposition from campaigners. A leading campaign group called "Sling the Mesh" has sought legal guidance to ensure no patients are put at risk with mesh operations. Legal advice claims that the NHS should not use the new NICE guidance as a "green light" for mesh operations. 

These guidelines come after baroness Cumberlege chaired an independent review into mesh side effects. Cumberlege recommended "high vigilance restriction" on surgical mesh until criteria could be met.

Opposing mesh operations, Sling the Mesh and Thompsons Socilitors have sent a letter to the NHS stating how NICE guidelines ignore the reasons why mesh implants were banned. They argue that the new NICE guidelines can't come back into effect into all conditions in the restriction have been satisfied. They also argue that the new guidelines will cause confusion for both patients and surgeons.

The NHS now face legal action if they do not confirm that they will not be restarting use of mesh. This is due to the NHS not meeting the six conditions attached to the July 2018 mesh restriction from baroness Cumberlege.

                                                                                      If you are considering surgery for stress incontinence, it recommended that you first ask your GP about natural treatment methods first. Doctors often suggest doing pelvic floor exercises, bladder retraining and making lifestyle changes. You can read about pelvic floor exercises here.

Have you or someone you know had a vaginal mesh implant? Post a question on our forum and tell others of the experience.