What are transvaginal mesh implants?

Introduced to the UK market in the mid-1990s, transvaginal mesh implants are used for treating urogynaecological conditions, which can be split into two categories:

• Stress Urinary Incontinence (SUI)
• Pelvic Organ Prolapse (POP)

Stress Urinary Incontinence

SUI refers to the leaking of urine during moments of physical exertion resulting in increased abdominal pressure. Common examples of physical exertion are coughing and sneezing, and high impact exercise.

SUI is the most common type of urinary incontinence in women and is more prevalent in women post-childbirth and during the menopause.

Pelvic Organ Prolapse

POP occurs when one or more of the organs sitting in the pelvic (such as the womb, bowel, bladder or top of the rectum) come down from their normal position and bulge in the vaginal canal.

Though women who have undergone trauma to their pelvic muscles and ligaments (such as childbirth) or hormonal changes as a result of the menopause are more likely to suffer from POP, heavy lifting and obesity may also result in a diagnosis of POP.

There are two classifications of POP:

• Asymptomatic: the organs or tissues drop but do not extend beyond the vaginal opening
• Symptomatic: the organs or tissues extend beyond the vaginal opening

Though not life threatening, POP often impacts a woman’s urinary, bowel and sexual functions, alongside her day-to-day physical discomfort.

How are transvaginal mesh implants used?

The most common type of mesh implant is transvaginal tape (TVT), which have been used across Europe, the United States of America and Australia since the early 2000s. This procedure involved attaching a synthetic polypropylene mesh sling to the affect area.

Benefits to transvaginal mesh implants surgeries

More efficient than the traditional treatment of extensive surgery involving suturing and the reconstruction and repair of the surrounding organs, the keyhole surgery allowed patients a quicker and less invasive option to treat SUI and POP.

Complications arising from transvaginal mesh implant surgery:

Though many women experience little to no difficulties, complications can occur immediately after an operation, or many years later. These complications range from mild discomfort to extreme pain, including:

• Irregular vaginal bleeding and/or discharge
• Vaginal scarring
• Discomfort during sex
• Bladder and bowel problems
• Pelvic pain and/or swelling
• Mesh erosion/extrusion

Post-transvaginal mesh implant insertion

Though increasing in popularity, many women began to speak out on their own experiences with transvaginal mesh implants, and the complications they have suffered as a result of the surgery. Support networks began to criticise the Government and healthcare providers for providing this treatment and called for tougher regulations in order to preserve patient safety.

As a result of the concerns raised, Jeremy Hunt MP, the then current Secretary of State for Health and Social Care, announced a review into the use of vaginal mesh in April 2018.

Following an independent safety review led by Baroness Cumberlege and the Independent Medicines and Medical Devices Safety Review, vaginal mesh procedures for SUI, and later POP procedures, were paused by NHS England.

The pause remains in place today, though has not been halted. The procedure can proceed as a last-resort option, following a high-vigilance programme.

Patient’s encounters

Kath Sansom (journalist and founder of ‘Sling the Mesh’)

• “The pain in my legs and feet was so intense, along with burning pains in my vagina…I knew something was terribly wrong”
• “I emerged [from the operating theatre] a physical wreck”

Kirsty Hammond (founder of SurvivingMESH.org)

• “I was never told that I was having a surgical mesh product implanted inside of me.’
• “For nine long weeks, I couldn’t sit up for longer than 30 minutes at a time.”

Useful information

Charities such as the Mesh UK Charitable Trust and Sling the Mesh offer victims and their families support and guidance. Sling the Mesh also campaigns for the implementation of all nine ‘First Do No Harm’ recommendations and enactment of a Sunshine payment for the UK. 

https://www.heraldscotland.com/news/23602277.mesh-implants-banned/?ref=twtrec

https://www.scottishmeshsurvivors.com/