Experts say it’s safe. So why is this incontinence op leaving many women in such agony?
Until four months ago, Kath Sansom was a self-confessed exercise junkie. Whether it was high- board diving, mountain biking or swimming, the 47-year-old mother of two was constantly active.
then, in March, she had an NHS operation that she was told would be quick and easy and would banish the stress incontinence she’d suffered since 2007, following the birth of her second daughter Daisy, at 9 lb 11oz.
Stress incontinence affects a third of women in the UK, causing urine to leak when there’s pressure on the bladder; often when coughing, sneezing, laughing or exercising. it occurs when the pelvic floor muscles are weakened. Childbirth is a common trigger.
‘Mine was the classic mum’s tale,’ says Kath, from Cambridgeshire. ‘i could have problems from sneezing, laughing or tram-polining with the kids. i battled through, but over the years it was getting worse. in hindsight, it was still quite mild, though.’
Her GP first offered surgery in 2007; the operation involved using transvaginal tape (TVT) — a plastic mesh implanted under the bladder like a hammock to support it. two 0.5cm cuts are made on the patient’s abdomen just above the pubic area, and another small cut is made in the vagina. the mesh is then passed through these cuts and placed around the urethra to form a sling.
Since its introduction in 1996, the opera-tion has quickly become the most popular nHS surgery for stress incontinence, and is performed on 13,500 women a year.
Previously, patients may have been referred for operations to support the bladder neck, such as a Burch colposus-pension, where the front wall of the vagina is lifted and stitched to a ligament behind the pubic bone. this would have to be done by specialist surgeons.
the mesh operation can be performed by surgeons with far less training.
Back in 2007, Kath declined the opera-tion as she thought surgery unnecessary. But last year she reconsidered.
‘i was getting problems such as leaking when hitting the punchbag at the gym,’ she says. ‘i was told by the GP’s nurse and the surgeon that the operation would only take 20 minutes and was minimally invasive, so what could go wrong?’
Kath’s problems began straight after the operation. ‘As i walked out of the hospital, i experienced a really bizarre dropping sensation and pain,’ she recalls. ‘then i began to have really horrible pain in my legs and groin.’
KAtH,a journalist on a local newspaper, had been advised she’d be fit to go back to work after a week. ‘But i could hardly walk up the steps to the office. the slightest thing made my legs and groin ache.’
Before the op, she’d also been told that her post-surgical symptoms would disappear after a fortnight.
‘instead, i promptly developed this really scratchy internal pain. that’s when i started Googling my symptoms.’ When she came across a December 2013 Good Health article highlighting the implant’s potential side- effects, Kath realised it was the mesh that was causing the problems.
She is one of thousands of British women who have been left with internal lacerations as a result of the procedure, according to the Department of Health.
these can cause difficulty walking, pain and infection, worsened incontinence and, for some, the end of a sex life.
Problems reported by doctors and patients include surgeons inserting the mesh incorrectly, damaging delicate internal organs.
the mesh can also break up in the body, with small fragments cutting surrounding tissue and causing excruciating pain.
the agony has had a significant impact on Kath’s life. ‘nowadays, i struggle just to walk the dog. i can’t do sports or hobbies as it hurts too much in my legs and groin. i spent yesterday mostly in bed because of the pain.’
She has launched an awareness campaign, Sling the Mesh, and is calling for a suspension of the procedure. in just five weeks, she’s been contacted by more than 500 women, from as far afield as new Zealand. ‘Many say they thought their problems were due to other causes until they heard about my campaign,’ says Kath.
Kath’s is the latest in a series of campaigns, including Meshies United, Messed Up Mesh and the Scottish Mesh Survivors.
Growing fears over the risks of mesh operations — official figures show complication rates can be as high as 15 per cent — have prompted the NHS to take action. NHS England, which says it is ‘ taking this issue very seriously’, has set up a working group of experts and aggrieved patients to look at clinical safety. it is also exploring whether a national register of patients is needed to provide a database of problems.
in March, the Scottish govern-ment’s chief medical officer, Dr Catherine Calderwood, wrote to all hospitals asking them to consider suspending the use of the synthetic mesh products until its safety has been properly reviewed.
Scotland’s Health Secretary Shona Robison also pledged to provide specialist support for women affected by mesh implants. Both the English and Scottish inquiries are expected to report at the end of the summer. they have been awaiting the conclu-sions of a study of the safety of mesh ops by the Cochrane Collaboration — an Oxford-based expert group pro-viding independent analysis of the effec-tiveness and safety of medical interventions. the Cochrane review was published last week, but its conclusions have shocked campaigners as well as a surgeon who’s spent years removing mesh from injured patients. it examined 81 trials involving more than 12,000 women, and said these showed 80 per cent of women with stress urinary continence were cured, or had significant improvement in their symptoms, for up to five years.
it concluded the operations ‘have a good safety profile’. the report acknowledged that 2 per cent of women who have the op suffer from the mesh breaking through their vaginal wall within five years of surgery, causing lesions and pain.
But the lead author said: ‘ if vaginal tape erosion does happen, it is quite easily treatable. this can be done by either trimming the tape down or providing oestrogen cream to help the vaginal wall repair itself.’
However, the report has been criticised by one of the two surgeons in Britain who have the specialist ability to remove the mesh from injured women.
Sohier Elneil, a consultant in urog-ynaecology and uroneurology at University College london Hospital NHS Foundation trust, says she is treating increasing numbers of women with TVT problems.
She says that most of the studies included in the Cochrane report do not deal primarily with complica-tions, but were conducted to assess the success in curing stress incontinence. She adds: ‘Further-more, even though the mesh is considered “safe” on the basis of this data, no clinical studies were ever done on humans before it started to be used in women’s vaginas and around their bladders.’
Miss Elneil also says the lack of knowledge around mesh and its potential problems means GPs, and even pain services, gynaecolo-gists and urologists, are often in the dark about the fact that symptoms women describe could be accounted for by the mesh.
‘Patients are commonly told that problems such as pain are “in their head” and that they should “get on with their life”,’ she says.
in addition, there are concerns about commercial influence. the Cochrane authors could not tell Good Health how many of the clinical trials were funded by medical device makers. ‘it is not explicit in the report,’ we were told. ‘But the vast majority of these trials were publicly funded.’
BUtMiss Elneil points out: ‘Even if a study covered by this report is not commer-cially funded, many of the physicians doing the studies have been funded, either now or in the past, by commercial interests.’
the report itself acknowledges that ‘most of our results are based on moderate-quality evidence’.
indeed, only two of the clinical trials studied were deemed to be at low risk of having statistical problems or biases that might have swayed the outcomes. And the three medics who wrote the Cochrane review paper are all involved with performing mesh operations, says Kath Sansom.
‘they naturally see the situation from the surgeon’s point of view, in which case my operation was a suc-cess as i am no longer incontinent.’
there are fears that the Cochrane report will affect the conclusions of the official inquiries.
Kath Sansom has now been referred to Miss Elneil and hopes to have the mesh removed in September. Until then, she has to live with the consequences of an op she wishes she’d never had.
‘the Cochrane report looked only at efficiency, not how the op can devastate women’s lives. My sex life is not going to be possible until this mesh is removed by a highly trained expert. Oestrogen cream is not going to fix that.’