Pelvic Mesh refers to polypropylene mesh implants to treat women treated for stress urinary incontinence or pelvic organ prolapse.
Complications include pain, inflammatary reactions to the mesh, persistent infections, bleeding, with the mesh kinking, moving or migrating and causing damage to surrounding organs.
The actual number of women who experience complications may be under-reported, so while some women experience the benefits from implants, other women experience any or all of these complications as they are listed below from Australia’s Therapeutic Goods Administration (TGA) website: 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
-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
-atypical vaginal discharge
-exposed mesh may cause pain or discomfort to the patient’s partner during intercourse
-swelling around the wound site
-excessive contraction or shrinkage of the tissue surrounding the mesh
-vaginal scarring, tightening and/or shortening
-granulation tissue formation.
Mesh, tape, sling - it is all polypropylene mesh. It is a complex area and rapidly changing so clinicians may not be aware that they are in essence, all the same. If you don't want mesh, you have the right to request native tissue repair or a procedure like a Burch colposuspension. It is your body and you need to feel confident you are providing informed consent.
Non-surgical options includes physiotherapy and pessaries. Surgery should be considered a last resort when all other options have been exhausted.
There are surgical options which don't include mesh such as Native Tissue Repair and Burch Colposuspension. Have a look at the Australian Commission on Safety and Quality in Healthcare's resources on this page for Pelvic Organ Prolapse and Stress Urinary Incontinence and remember the key advice that surgery should be the last resort when all other options have been exhausted.
You will be the one who will bear the consequences if you do have complications from the mesh, so it's important that you provide informed consent. 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 - plus it is useful to ask how many of the same procedures your surgeon has done, and what the outcomes have been. Any reluctance to answer this question may signal you have not found the right surgeon for you.
No it is not banned. It has been banned for some, but not all types of pelvic organ prolapse surgery, but for the most common surgery, stress urinary incontinence, it has not been banned. From 1 December 2018, all new surgical mesh devices seeking approval from the TGA will need to meet the higher evidentiary requirements of a Class III medical device. This does not apply to mesh devices already on the TGA register however.
It is very difficult to fully remove mesh. Women are offered partial removals of mesh, for example snipping of the part protruding through the vaginal wall. Many women do not want partial removals as the remaining mesh frays and causes ongoing issues, and it may be more difficult to get the rest of the mesh out. Some women have taken the decision to self-fund and travel overseas to where other surgeons more experienced in full mesh removal may be able to provide assistance. We are continuing to work on this as a nation and the options are continually evolving. The WA Pelvic Mesh Support Group can be an important source of support to find out latest options, or you can call the Health Consumers Council on 9221 3422/ 1800 620 780 for country callers, or email email@example.com
The Therapeutic Goods Administration (TGA) regulates medications and medical devices. However, the evidence required to register a device is by no means as comprehensive as that required to register a medication.
You can register your complications on The Therapeutic Goods Administration (TGA) website here: https://www.tga.gov.au/alert/urogynaecological-surgical-mesh-complications
You can also call the Mesh Line if you are in WA on 1800 962 202
A Senate Inquiry into pelvic mesh was held in 2017, and the Recommendations have largely been accepted by our nation's Health Minister, who apologised to women harmed by mesh implants. They are currently in the early stages of being implemented, and health consumer councils across Australia are working with key bodies to ensure that there is a more consistent approach across Australia.
Hernia mesh is emerging as the next key area of interest. The complications are very similar, as is the negative impact on people, and the difficulties they can face in getting help. A new peer group has been started in WA - Mesh Too Western Australia.