TIME TO TALK COMMONSENSE ON INCONTINENCE TREATMENTS
Australian doctors are “despairing” at a UK decision to immediately suspend the use of mid urethral mesh slings (MUS) for urinary incontinence, the Urogynaecological Society of Australasia (UGSA) says.
UGSA chair Dr Jenny King says the move is a big step backwards for women who are suffering from stress urinary incontinence – involuntary urine leakage – and will have negative repercussions worldwide.
Why do women’s lives need to be disrupted? And how can we be confident this will not happen in Australia?”
“We don’t reintroduce bloodletting because some antibiotics have side-effects – so we can’t go back to older continence procedures with higher complications rates, simply because they don’t involve mesh.”
She said women were already living in a state of fear about MUS after a campaign against the procedure, with some even resorting to sub-standard surgeries without mesh or simply living with their condition.
But UGSA states the lightweight, minimally invasive slings are the safest and most effective surgical treatment for urinary incontinence, having been used in Australia and NZ since 1998.
“So as doctors, we are left despairing at decisions like those made in the UK, as well as the Australian Senate inquiry recommendation that mesh be used only as a last resort,” Dr King said. “The mid urethral sling is not a last resort – it is an excellent option for most women for whom conservative treatment for urinary incontinence has failed.
“There is indisputable evidence to support this – so what more proof do we need?”
She said there was much to learn from patients who had experienced poor outcomes from mesh surgery, and the best possible mechanisms for research, training and patient monitoring were being established. “But we can’t go backwards, this is not a solution.”
Dr King said women should be able to make the decision for themselves, arguing UK had already conducted several large inquiries into mesh use and developed strict guidelines for training, auditing and thorough processes for women to be informed before undergoing surgery.
Read full statement by Dr Jenny King, Chair UGSA:
“The NHS in the UK has instructed hospitals to immediately “pause” or suspend the use of mid urethal mesh slings (MUS) for urinary incontinence.
Thousands of women scheduled for surgery suddenly had their treatment put on hold, despite careful assessment after conservative methods failed.
The directive followed a recommendation from Baroness Julia Cumberlege, chair of the Independent Medicines and Medical Devices Safety Review, which held meetings with women who experienced adverse mesh surgery outcomes.
The formal NHS position statement to all NHS trusts and medical directors states: “There is no concurrent change in the evidence base.”
Which means that this decision has been made despite there being no new evidence. They have come to a decision contrary to all the evidence and which is out of step with decisions made by every medical and regulatory body.
In the last few years, we have become increasingly aware that some women have experienced serious complications following transvaginal mesh surgery. In response, medical and regulatory bodies worldwide, including in Australia, have instituted extensive regulations around appropriate use, training, credentials and auditing for these operations. Similarly in the UK, only senior trained surgeons can perform mesh procedures. The British Society for Urogynaecology database is used for auditing and reporting complications while the National Institute for Clinical Excellence has developed guidelines for the use of mid urethral slings.
But it is important to note that the safety and efficacy of the mid urethral sling procedure for stress urinary incontinence has been recognised. This is the most extensively researched continence procedure and we have been conducting follow-ups with patients for almost twenty years. The mid urethral sling has been endorsed as the standard surgical management for incontinence by every national and international body involved in women’s health, including the Urogynaecological Society of Australasia, the Australian Commission for Safety and Quality in Health Care, the Royal Australian College of Obstetrics & Gynaecology and Australian Urological Association. The International Urogynecology Association has just released a Global Position Statement on the safety and efficacy of mid urethral slings, which was ratified by 22 national urogynaecology societies.
So as doctors, we are left despairing at decisions like those made in the UK, as well as the Australian Senate inquiry recommendation that mesh be used only as a last resort. The mid urethral sling is not a last resort – it is an excellent option for most women for whom conservative treatment for urinary incontinence has failed.
There is indisputable evidence to support this – so what more proof do we need?
It is a sad fact of medicine that no single treatment works for every patient and that despite extensive research, some may go terribly wrong. We have to recognise this, investigate why it happened and try harder to prevent such problems occurring again. And certainly, there is much to learn from patients who have had a poor outcomes from mesh surgery.
But we can’t go backwards. We don’t reintroduce bloodletting because some antibiotics have side- effects – so we can’t go back to older continence procedures with higher complications rates, simply because they don’t involve mesh. This is not a solution.
We cannot guarantee there will never be another medical mishap. But we can set up the best possible mechanisms for research, training and patient monitoring. And that is exactly what we are doing.
Surgeons and medical regulatory bodies have been accused of being slow to identify mesh problems – and even slower to respond. This is probably accurate, but we do have systems in place to manage medical products and procedures which are not fit for purpose. This is evidenced by policies implemented in Australia by the TGA, ACQSHC, state health departments and in the UK by NICE and the NHS. Medical management by legislators is not the appropriate way to ensure good patient care.
Of course, we want a society and a government which is answerable to its citizens and where minorities can be heard. But do we really want a society where poorly thought-out, retrograde decisions are made by well-meaning but non-medically trained crusaders with blinkers?
We now have very strong guidelines in place for the use of transvaginal mesh – we ask that these be allowed to work, so we can look after our patients to the best of our ability.”
To get help for bladder and pelvic floor health:
- Visit our website: www.ugsa.com.au
- Call the free National Continence Helpline 1800 33 00 66 • Go to www.continence.org.au
- Or talk to your doctor
For all media enquiries, please contact:
ph. 0431 27 41 69
Media interview opportunities exist with:
Dr Jennifer King OAM FRANZCOG CU, Chair UGSA, Program Chair Education Committee IUGA, Director Pelvic Floor Unit, Westmead Hospital.
Patient case studies are available upon request.
Dr King is a urogynaecologist and chair of the Australasian Urogynaecology Association which represents many of the surgeons who have used transvaginal mesh for treatment of incontinence and prolapse.
Connect with Dr Jennifer King on LinkedIn
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