Unmeshing mental toll of implant issues
Team finds higher risk of depression, self-harm in women facing complications after incontinence surgery
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 wellbeing 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 selfharm 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 lifechanging... 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. jbie[email protected]media.com twitter.com/JenatLFPress
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.