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Not all vaginal implants are a problem and treating them the same puts many women at risk.

June 6, 2018

The fallout from the mesh scandal is having major consequences on women’s health, as many are too fearful to get proper treatment.

But not all vaginal implants are a problem and treating them the same puts many women at risk.

Worryingly, the chair of UroGynaecological Society of Australasia has revealed that specialists are being asked to perform sub-standard surgery as women are too “frightened” to undergo a mesh transplant.
 
“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,” said Dr Jenny King.

“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?”
 

FAST FACTS:

Around one in five Australian women might need surgical treatment for prolapse or urinary incontinence. Treatment can improve quality of life.

80 per cent of those affected by incontinence are women, with more than half aged 50 and under.

In 1998 when MUS was first introduced to Australia, 73.3 women per 100,000 (ages >25 years) had surgery for urinary incontinence.

The MUS rapidly replaced all other surgeries from 2002 and by this time significantly more women were having surgery for their incontinence.

The peak rate of all surgical procedures was 108 per 100,000 women in 2002. The rate in 2017 was 53 per 100,000 – a fall of 51 per cent.

 

A SHARP drop in the number of women seeking treatment for incontinence is being blamed on fear generated by a campaign against vaginal mesh.

The Urogynaecological Society of Australasia (UGSA) today reveals young women aged between 35-44 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 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 25-54 .

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 sub-standard surgery without mesh, as women had been exposed to inaccurate, alarming 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 has lumped together incontinence and prolapse devices, considering them all to be “transvaginal meshes”, even though only the prolapse devices were problematic.

Those used for incontinence, called mid-urethral slings (MUS), were safe and evidence-based procedures.

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.

She said doctors were worried about women turning to “snake-oil” alternatives, citing aggressive advertising by laser manufacturers for a treatment that was “completely unsubstantiated”.

“Operators require no skills in pelvic floor medicine and we have no way of monitoring for complications,” she said.

“It is also hugely expensive for patients.”

UGSA states lightweight, minimally invasive mid-urethral slings are the safest and most effective surgical treatment for urinary incontinence, having been used in Australia and NZ since 1998.
They have been extensively studied for almost two decades with results published in more than 2,000 scientific publications.

The mid-urethral sling is supported as the operation of choice for stress urinary incontinence by every woman’s health and pelvic floor society in Europe, the United Kingdom and the USA.

The US FDA statements on safety concerns over transvaginal mesh do not include mid-urethral slings and the Australian Therapeutic Goods Administration (TGA) has continued to support the inclusion of these products on the Register of Therapeutic Goods.

The Australian Commission on Safety and Quality in Health Care (ACSQH) released the hospital credentialing guidelines for MUS stating: “There is robust evidence nationally and internationally to support the use of the traditional mid-urethral sling for stress urinary incontinence in appropriate cases.”

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists also recommends the MUS as it is highly effective in the short and medium-term, 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.”

These recommendations have also been made by the ACSQH and many are included in the Senate recommendations.

Continence Foundation of Australia CEO Rowan Cockerell said: “Incontinence is a massive problem affecting more than 5 million adult Australians and costing the Australian economy more than $67 billion a year.”

Dr King continues, “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.” 

“It is important to clarify that the TGA has removed from the register only those transvaginal meshes used for treatment of prolapse. The mid-urethral 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.” 

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

 

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