Is Mesh Revision Possible?
A recent study from the concerning mesh revision by the U.S. Food and Drug Administration and Health Canada stated that the rate of revision or removal of vaginal mesh sling was low (about 1 in 30 after 10 years). These are ladies who have had a synthetic vaginal mesh sling as part of surgery for stress urinary incontinence and then require mesh revision. These are ladies who have experienced problems such as chronic pain, infection and inability to have intercourse. So is mesh revision possible in whole or part?
What is interesting is that the very nature of mesh means that it cannot be removed (at least not in full). Thus one would expect to see such results not because the product works but because you cannot remove it!
Whilst certain surgeons undertaking mesh revision can remove sections it only creates more problems. More scar tissue is created and there is a substantial surgical risk in attempting to do so. Many ladies are so traumatised after undergoing mesh insertion that the thought of further surgery is not an option. Indeed, there are many surgeons who are confident to put mesh in but would not attempt to remove. Instead they should refer ladies to a multi-disciplinary team (MDT) elsewhere in the UK.
Why Do You Need Mesh Revision?
The study also showed that patients of lower-volume surgeons were 37% more likely to require revision than those treated by high-volume surgeons. This is logical because those with less training and experience are more likely to make a mistake. This is not a surgery to be undertaken lightly. Whilst it may be a commonly performed same day procedure it is certainly not a surgery with low levels of complications.
Quality surgical care requires high levels of training in a multi-disciplinary team (MDT), coaching, mentoring and mandatory reporting of outcomes. Patient safety should be at the heart of mesh surgery. The complications and litigation surrounding both the product and clinical negligence cannot be ignored.
Problems With The Research
It is also noted that these studies failed to identify the type of sling used which would have been helpful to identify if a particular product resulted in more mesh revision than others. This information would have been readily available in the medical records. It also failed to note the degree of incontinence a woman was experiencing before surgery. Many of our patients are only at the ‘cough & sneeze’ stage when surgery is recommended and performed which is wholly inappropriate.
Lastly, the study failed to consider complications that were treated without surgery or that were not treated at all.
Dr Victoria Handley wishes to thank Blayne Welk, MD, from the Department of Surgery, Western University, St. Joseph’s Health Care, London, Ontario, Canada, and colleagues who wrote the original article published online September 9 in JAMA Surgery (funded by a Astellas a pharmaceutical company with an interest in urology) and Christian Meyer, MD, from the Center for Surgery and Public Health and Quoc-Dien Trinh, MD, from the Division of Urologic Surgery, both at Brigham and Women’s Hospital, Boston, Massachusetts, who writes an accompanying article. Click here for the article.
If you have been harmed by TVT/TOT mesh and have had or are contemplating a mesh revision, then please get in touch with Dr Victoria Handley on 0800 470 2009 or firstname.lastname@example.org