Ask for traditional surgery rather than pelvic mesh implants, says study out this week
PUBLISHED: 16:03 04 January 2017 | UPDATED: 16:03 04 January 2017
Mesh implants to fix pelvic organ prolapse have higher risks than traditional surgery but no extra benefits, according to a report released this week.
Pelvic floor exercises and pessaries for prolapse should be used as a first line treatment before women agree to go under the knife, the report adds.
The findings have been welcomed by campaigners who say it is vital the medical community properly inform women of the life changing risks of all mesh implants.
The future of mesh slings for incontinence in Scotland and England will be outlined in reports due to be published in the new year.
MP Jackson Carlaw, deputy leader of the Scottish Conservative party, said: “With review after review challenging the complacency of the MHRA, some Scottish health boards and with evidence of horrendous consequences of mesh flowing in from countries across the world, this scandal will finally be laid bare in 2017.
“Too many women have been let down and I hope that Scotland takes the lead in providing the justice they seek.”
Elaine Holmes of Scottish Mesh Survivors, said: “There are no benefits of mesh so why take the risk?
“Alternative treatment options are available.”
Kath Sansom of Sling The Mesh said: “The study showed 12 per cent of women suffered complications after a prolapse fix using mesh but these women were only followed up for two years.
“Problems can cut in later so the true figure is likely to be higher. Women must demand traditional surgical fixes and surgeons must stop telling them that prolapse mesh is safe when in fact it carries unacceptable risk.”
The PROSPECT study, carried out by researchers at Aberdeen University, followed women in 35 hospitals across the UK having procedures with 65 surgeons.
It said women should try pelvic floor exercises and pessaries as a first line of treatment for prolapse.
“Women should be reassured that if they do need surgery, they ought to go ahead with standard operations,” the report said.
“The use of transvaginal mesh and biological graft material in prolapse surgery is controversial and has led to a number of enquiries into their safety and efficacy.
“Repair with mesh or graft material did not improve women’s outcomes in terms of effectiveness, quality of life, adverse effects, or any other outcome in the short term, but more than one in ten women had a mesh complication.
“Follow-up is vital to identify any longer-term potential benefits and serious adverse effects of mesh or graft reinforcement in vaginal prolapse surgery.
Prof. Cathryn Glazener health services research unit at the University of Aberdeen, said: “Prolapse is a condition that affects up to half of women after childbirth.
“Women who have surgery for prolapse have a three in 10 chance of needing at least one more operation, so the success rate is not great.
“Gynaecologists hoped that by reinforcing their repairs the success rate would get better.
“We found, in contrast to previous research, women were just as likely to be cured after standard surgery rather than reinforced repairs.
“They were just as likely to have other symptoms such as bladder or sexual problems, and other adverse effects such as infection, bleeding or pain.”
Around one in 10 women implanted with mesh suffered exposure - where a portion of mesh becomes visible through the vaginal wall, she added.
“About half of those women needed a small operation to remove or bury the exposed mesh,” she said.
“Synthetic mesh did result in some complications which posed extra risk.
“Researchers and clinicians need to work together to identify better operations, or reduce the prolapse symptoms using other means.”
Two other papers published this week draw attention to care for women with pelvic floor dysfunction.
Researchers from the Information Services Division (ISD) said long term results from mesh prolapse surgery are no better than from standard repair, echoing the PROSPECT findings.
The PrevProl study showed that pelvic floor exercises should be tried as a first line of treatment.
• The reports were released in the same week that a Freedom of Information request by the BBC showed that 404 women have been given mesh implants in Scotland despite a suspension being called for by the Scottish health secretary in June 2014.
Health boards still using mesh implants said they discussed all the potential risks with patients before surgery.
• Over the past 20 years, more than 20,000 women in Scotland have had mesh or tape implants.
• In England around 13,000 women a year are given mesh implants.
• The MHRA say the risk is around one to three per cent but figures calculated by campaigners say the risk is more like 8.56 per cent.
• The risk figure is calculated by women reporting their mesh complications to the MHRA Yellow Card system or surgeons reporting to the British Society of Urogynacology database. It is not mandatory for surgeons to report to either.
• Pelvic mesh implants are a global concern. Scottish MP Neil Findlay has called them the worst medical disaster of our time, Welsh MP Owen Smith said it is the worst health scandal he has seen in his time as a politician and Australian senator Derryn Hinch said it is a bigger scandal than Thalidomide.