If you are wondering whether to have synthetic mesh inserted for stress urinary incontinence or pelvic organ prolapse, then you may wish to consider these ten good reasons for avoiding mesh. Here are ten very good reasons below to avoid mesh:
- It’s a flawed product. Basically, vaginal mesh is a cheap woven plastic material which does not belong inside the human body; it may produce chronic inflammation, and it can degrade, shrink and move inside the body, wreaking havoc as it goes. It is linked to autoimmune reaction in some women, and the long term effects of having the product inside the body are not known, as it is a relatively new product.
- It’s a flawed procedure. Firstly, mesh is usually placed via the vagina which is not a sterile area and this may result in infection. Secondly, large steel needles (which lead the way for the mesh) are blindly inserted into the retropubic or obturator space leading to potential nerve or organ damage.
- It’s experimental. There’s not enough data on mesh surgery to evaluate its safety and reports are now emerging of more and more women being harmed by mesh. There are no national registries of mesh surgery. New mesh products are coming on to the market regularly. In the UK, we do not even know on what grounds each mesh product is approved. If you have this surgery, you become a live test subject for the mesh product you are receiving.
- It’s a permanent medical device. You may not be aware of this simple fact – many women aren’t, believing it to be just a soft supportive tape. Your surgeon may have neglected to mention that it’s intended to be a permanent implant. Once it’s inside your body, it’s in for life even if it doesn’t work. Once it becomes enmeshed in your tissues at around 6 weeks, it can be difficult to remove if you have any problems.
- It’s no more successful than non-mesh surgery yet poses additional risk. Studies quoted by NICE do not demonstrate any significant benefit to having mesh and yet NICE promote this procedure on the grounds that it saves the NHS money. There is evidence that mesh poses additional risk, in particular the risk of erosion and damage to organs, and these risks are lifelong.
- Patient selection is a myth. Doctors rarely practise careful patient selection as advocated in many studies on mesh, and even if they claim to do so, there seems to be no agreement on what makes the ‘perfect’ mesh candidate. As the operation has grown in popularity, so has the range of patients deemed eligible for this so called gold-standard treatment. Some studies have described risk factors (such as a slow flow) which may affect success but whether surgeons take note of these or just ‘suck it and see’ is another matter.
- Surgical expertise is a myth. The art of sling surgery is in the correct placement and precise tensioning of the sling – that’s how all sling surgery works. Too tight and you have voiding problems. Too slack and the sling won’t be effective. The law of averages means some doctors will be better than others but some will be worse and even the ‘best’ surgeons will get it wrong from time to time. Plus, there’s no guarantee who will operate on you once you are under anaesthetic.
- Mesh erosionis a very unpleasant consequence of mesh surgery and can result in pain, infections and difficulties with intercourse. If the serrated edges of the mesh begin to poke through your vaginal tissues, not only is it painful for you, but it could lacerate your partner’s penis. If you thought ‘vagina dentata’ was the stuff of science fiction horrors, think again.
- Difficulties with bladder emptying and storage may be permanent and disabling – there may be a long term need to catheterise or you may develop irritative symptoms or urge incontinence which you never experienced before. You may require further surgery to remove the mesh, that’s if you can find someone who recognises your problems as mesh-related and who can safely remove the mesh for you.
- Pain in the vagina, pudendal region, pubic region or groin and even buttocks, thigh and legs can be another very unpleasant consequence and can result from a wrongly-placed or over-tight sling, or from nerve damage or irritation, or from infection or eroding mesh. This pain might not go away.
Don’t rush in to mesh surgery – make sure you have all the facts because the surgeon might not give you them. You don’t have to agree to having mesh. Ask about alternatives.