Pelvic Mesh refers to polypropylene mesh implants to treat women treated for stress urinary incontinence or pelvic organ prolapse. There has been significant media coverage on the topic, including an episode on The Project. Media coverage highlights the little known reality that when a pelvic mesh implant goes wrong, it can go badly wrong, with life-changing, permanent effects. Complications can occur any time from straight after surgery to years afterwards. The Therapeutic Goods Administration has recently updated the list of complications and these are listed at the bottom of this page.
The Australian Pelvic Mesh Support Group is a key resource for women affected. At the beginning of the year there were 400 members but this number has ballooned out to more than 1,000 in the wake of the media coverage.
Women face many barriers when seeking treatment after things have gone wrong. Getting diagnosed can be very difficult, and most of the care is poorly co-ordinated and mainly in the private sector, causing a cost burden to the women impacted. Currently there only partial removal options for women, and it would appear that Western Australia does not have the right equipment or staff to determine when the mesh has migrated from its original placement, a common complication.
The health consumers councils across Australia have developed a Consumer Information Sheet which appears below and is also available as a PDF. Please contact us on firstname.lastname@example.org or 9221 3422 if you have any comments or concerns.
For women who have had, or are considering having surgery to treat stress urinary incontinence and pelvic organ prolapse
If you have been diagnosed with pelvic organ prolapse or stress urinary incontinence, it is important to explore non-surgical options such as physiotherapy and pessaries. It is important that all non-surgical options have been exhausted before surgery is considered.
Surgery for these two conditions are usually involves a mesh insertion or implant. It might be called tape or a sling. It is all the same from a consumer perspective and these products are collectively known as mesh. The Therapeutic Goods Advisory Website has an updated list of complications associated with surgery using mesh. https://www.tga.gov.au/alert/urogynaecological-surgical-mesh-complications
Mesh implants have been offered to women since the late 1990s. The procedure is considered to be only partially reversible, and some women have travelled to America at their own expense to have mesh removed.
There may be other surgical options such as native tissue repair for you to discuss with your clinician. Before you consent to any surgical procedure, it is important to ask all the questions you need so you understand what you are consenting to. The Choosing Wisely campaign has created these questions to help you get started. http://www.choosingwisely.org.au/resources/consumers/5-questions-to-ask-your-doctor
1. Do I really need this test or procedure?
Tests may help you and your doctor or other healthcare provider determine the problem and the procedures that may help to treat it.
2. What are the risks?
Will there be side effects? What are the chances of getting results that aren’t accurate? Could that lead to more testing or another procedure?
3. Are there simpler, safer options?
Sometimes all you need to do is make lifestyle changes, such as eating healthier foods or exercising more. Another option to ask your doctor about is native tissue repair.
4. What happens if I don’t do anything?
Ask if your condition might get worse — or better — if you don’t have the test or procedure right away.
Stress urinary incontinence is not a life-threatening condition so consider carefully before undergoing any surgery. Do not consider surgery until all non-surgical options have been exhausted.
5. What are the costs?
Costs can be financial, emotional or a cost of your time. Where there is a cost to the community, is the cost reasonable or is there a cheaper alternative?
What help can I access?
Having A Say
Complications associated with use of Pelvic Mesh
These are listed on Australia’s Therapeutic Goods Administration (TGA) website as follows: https://www.tga.gov.au/alert/urogynaecological-surgical-mesh-complications
- punctures or lacerations of vessels, nerves, structures or organs, including the bladder, urethra or bowel (these may require surgical repair)
- transitory local irritation at the wound site
- a ‘foreign body response’ (wound breakdown, extrusion, erosion, exposure, fistula formation and/or inflammation)
- mesh extrusion, exposure, or erosion into the vagina or other structures or organs
- as with all foreign bodies, mesh may potentiate an existing infection
- over-correction (too much tension applied to the tape) may cause temporary or permanent lower urinary tract obstruction
- acute and/or chronic pain
- voiding dysfunction
- pain during intercourse
- neuromuscular problems including acute and/or chronic pain in the groin, thigh, leg, pelvic and/or abdominal area
- recurrence of incontinence
- bleeding including haemorrhage, or haematoma
- urge incontinence
- urinary frequency
- urinary retention
- adhesion formation
- atypical vaginal discharge
- exposed mesh may cause pain or discomfort to the patient’s partner during intercourse
- mesh migration
- allergic reaction
- swelling around the wound site
- recurrent prolapse
- excessive contraction or shrinkage of the tissue surrounding the mesh
- vaginal scarring, tightening and/or shortening
- constipation/defecation dysfunction
- granulation tissue formation.
Author: Pip Brennan, Executive Director of the Health Consumers’ Council. Consumer Member on the Australian Commission on Safety and Quality in Health Services Transvaginal Mesh Reference Committee.