Un­mesh­ing men­tal toll of implant is­sues

The Beacon Herald - - LIFE - JEN­NIFER BIEMAN

London, Ont., re­searchers are ze­ro­ing in on the po­ten­tial psy­cho­log­i­cal ef­fects of com­pli­ca­tions from women's in­con­ti­nence surgery, un­cov­er­ing an in­creased risk of de­pres­sion and self-harm after the cor­rec­tive surgery.

A team from the West­ern Uni­ver­sity branch of Toronto-based In­sti­tute for Clin­i­cal Eval­u­a­tive sciences and Law­son health re­search In­sti­tute — the re­search arm of the London Health Sciences Cen­tre and St. Joseph's Health Care London — ex­am­ined pa­tient out­comes after pelvic mesh im­plants from Jan­uary 2004 to De­cem­ber 2012. us­ing 12 years of data from On­tario's pub­lic health-care sys­tem, re­searchers stud­ied the files of 57,611 women who un­der­went the midurethral mesh sling pro­ce­dures. Of those, 1,586 went un­der the knife again to cor­rect a com­pli­ca­tion from the mesh. study au­thors ex­cluded women who had un­der­gone pre­vi­ous stress in­con­ti­nence pro­ce­dures and ones those with a his­tory of de­pres­sion or self-harm­ing be­hav­iour.

Re­searchers found an in­creased risk of men­tal health is­sues in women who had surgery to cor­rect a com­pli­ca­tion when com­pared to the group whose ini­tial pro­ce­dure was suc­cess­ful.

"It's im­por­tant to look at qual­ity of life and psy­cho­log­i­cal well-be­ing for these women," said Blayne Welk, se­nior study au­thor and urol­ogy sur­geon at st. Joseph's. "It's some­thing I've sort of anec­do­tally no­ticed in clinic when I was see­ing pa­tients, that there was a lot of emo­tional dis­tress as­so­ci­ated with a lot of these pa­tients." The pop­u­la­tion study found 11 per cent of women who un­der­went surgery to fix a mesh com­pli­ca­tion were treated for de­pres­sion, com­pared to eight per cent of pa­tients who didn't re­quire a cor­rec­tive pro­ce­dure. The study found 2.77 per cent of women who went un­der the knife again to fix a mesh com­pli­ca­tion re­ported self-harm be­hav­iour, com­pared to 1.15 per cent who didn't need cor­rec­tive surgery.

The psy­cho­log­i­cal risks were higher in women younger than 46, the study says.

Mesh im­plants area com­mon treat­ment op­tion for stress uri­nary in­con­ti­nence in women — urine leaks that hap­pen dur­ing phys­i­cal ac­tiv­ity.

The plas­tic mesh sling, im­planted through a min­i­mally in­va­sive sur­gi­cal pro­ce­dure, gives ex­tra sup­port to the ure­thra so urine can't seep out when the blad­der is put un­der pres­sure by phys­i­cal move­ments, such as lift­ing, cough­ing, sneez­ing or laugh­ing.

A suc­cess­ful sling op­er­a­tion can be a life-im­prov­ing pro­ce­dure that lets pa­tients move and go about their daily ac­tiv­i­ties leak-free, Welk said.

But like any surgery, there are risks of com­pli­ca­tions. some pa­tients can ex­pe­ri­ence chronic pain after the pro­ce­dure. Oth­ers might still ex­pe­ri­ence in­con­ti­nence. In some cases, tiny bits of the mesh could be­come ex­posed and poke through other tis­sue.

Com­pli­ca­tions from mesh im­plants, in­clud­ing midurethral slings, have sparked class-ac­tion law­suits and Health Canada alerts in re­cent years.

Lin­ger­ing post-op­er­a­tive is­sues — and the pri­vate suf­fer­ing that can ac­com­pany them — can make pa­tients ques­tion their decision to seek surgery, Welk said.

"I think a lot of it is de­ci­sional re­gret, al­most. Women elect to un­dergo a pro­ce­dure that's min­i­mally in­va­sive that's meant to treat a qual­ity-of-life issue," Welk said. "There's that small pro­por­tion of women that do have sig­nif­i­cant com­pli­ca­tions... (that) can be life-chang­ing... That can be a big thing (to live with)." The psy­cho­log­i­cal im­pact of mesh com­pli­ca­tions — or other un­fore­seen post-surgery is­sues — shouldn't be un­der­es­ti­mated, Welk said.

"I think we don't of­ten think about the psy­cho­log­i­cal im­pact of com­pli­ca­tions after surgery. I think what this re­search shows is there's a con­sid­er­able bur­den placed on women, par­tic­u­larly young women, who suf­fer com­pli­ca­tions after a midurethral sling," Welk said. "That's some­thing to take into ac­count when eval­u­at­ing these pa­tients." The study is pub­lished on­line in the lat­est edi­tion of JAMA surgery, an Amer­i­can Med­i­cal As­so­ci­a­tion re­search pub­li­ca­tion. London Free Press

DEREK RUTTAN/POST­MEDIA NEWS

Urol­o­gist Dr. Blayne Welk says women with painful com­pli­ca­tions from mesh im­plants, used to stop in­con­ti­nence, have a sig­nif­i­cantly high in­ci­dence of de­pres­sion and self-harm.

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