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‘Not all vaginal implants are a problem’: Doctor says women are refusing to seek treatment for incontinence after hundreds claimed mesh left them in pain and ruined their sex lives.

June 6, 2018

SHEREE MUTTON FOR DAILY MAIL AUSTRALIA

 

* Figures show a drop in women are seeking treatment for incontinence

* Doctor Jenny King believes it’s because they’re fearful of vaginal mesh

* The TGA removed transvaginal mesh for the sole purpose of pelvic prolapse

* Dr King said those used for incontinence ­ mid­urethral slings (MUS) ­ were safe

There has been a sharp drop in the number of women seeking treatment for incontinence and doctors say it’s because they’re fearful of vaginal mesh.

The Urogynaecological Society of Australasia (UGSA) has revealed that young women aged between 35­44 are the most likely to put up with incontinence due to concerns over mesh implants, impacting their work, quality of life and mental health.

Figures show there has been a 41 per cent decline in stress incontinence surgery in the age group since peak rates in 2009, and 32 per cent in women aged 25­54.

It comes after UGSA raised serious concerns at the Australian Senate Committee Inquiry recommendation that implantation of all transvaginal mesh products only be undertaken as a ‘last resort’ by women with urinary incontinence and pelvic floor conditions.

UGSA chair Dr Jenny King said about 150,000 meshes have been used in Australia for prolapse and incontinence, with a 95 per cent success rate.

But she said specialists were now being left with no choice but to perform sub­standard surgery without mesh, as women had been exposed to inaccurate information.

‘I think the fall in patients seeking treatment for their incontinence is evidence of the fear generated by adverse publicity, social media and the Senate inquiry,’ she said.

‘Anecdotally we have all had patients with severe and recurrent prolapse who are simply too anxious to contemplate a mesh repair even though it really is their only chance of a good outcome.

‘At the moment I am performing prolapse procedures without mesh which I know have an extremely high chance of failure ­ simply because of patient anxiety. ‘They will then be faced with further, more complex surgery with greater rates of complications. This is poor practice but what else can we do?’

She said the Senate had lumped together incontinence and prolapse devices, considering them all to be ”transvaginal meshes”, even though only the prolapse devices were problematic.

Last year, hundreds of Australian women claimed the mesh left them with debilitating, chronic pain and they were unable to have sex again.

The Therapeutic Goods Administration decided in November to remove transvaginal mesh for the sole purpose of pelvic prolapse and single incision

mini­slings from the Australian Register of Therapeutic Goods (ARTG).

However, Dr King said those used for incontinence, called mid­urethral slings (MUS), were safe.

A prolapse is when pelvic organs – such as the bladder, bowel or uterus – fall through the vagina.

Stress urinary incontinence is involuntary urine leakage with activity such as sport, coughing or even walking. It affects up to 37 per cent of Australian women, according to the Australian Institute of Health and Welfare.

UGSA states lightweight, minimally invasive mid­urethral slings are the safest and most effective surgical treatment for urinary incontinence, having been used in Australia and New Zealand since 1998.

The US FDA statements on safety concerns over transvaginal mesh do not include mid­urethral slings and the Australian Therapeutic Goods

Administration (TGA) has continued to support the inclusion of these products on the Register of Therapeutic Goods.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists also recommends the MUS as it is highly effective in the short and medium­term, with fewer adverse outcomes than other available major continence surgeries.

‘MUS have been clearly shown to be safer and more effective with a lower complication rate than our previous continence procedures,’ said Dr King.

‘UGSA believes the way forward lies in rigorous safeguards including ongoing audit, long term monitoring, careful surgical training and research with thoughtful patient selection and counselling.’

Dr King said it was important to clarify that the TGA had removed from the register only those transvaginal meshes used for treatment of prolapse.

‘The mid­urethral mesh slings have been recognised in Australia and worldwide, by all medical and regulatory agencies, as the appropriate treatment for stress urinary incontinence and these continue to be available.’

‘Much work still needs to be done to help those women who have had adverse outcomes but this should not be at the expense of other women who will benefit from these treatments,’ she said.

Continence Foundation of Australia CEO Rowan Cockerell said that incontinence was a concern for millions of people.

‘Incontinence is a massive problem affecting more than five million adult Australians and costing the Australian economy more than $67 billion a year,’