Are surgeons correctly trained? Leading Italian surgeon says mesh used in women’s operations has a high rate of complications

Professor Stefano Salvatore, president of the European Urogynaecology Association

Professor Stefano Salvatore, president of the European Urogynaecology Association - Credit: Archant

A leading medic says surgeons do not have the correct certification to carry out certain women’s mesh operations which carry a high risk of complications and pain.

Surgeons carrying out mesh operation have been asked to make sure they carry the appropriate certifi

Surgeons carrying out mesh operation have been asked to make sure they carry the appropriate certification - and to report problems to yhe MHRA - Credit: Archant

Twelve years after publishing a report calling for plastic mesh to be stopped for pelvic organ prolapse repair, Italian surgeon Professor Stefano Salvatore, has again spoken out again against polypropylene material used in gynaecology surgery.

His plea comes amid figures that show the risk of bladder slings for female incontinence in England is 8.56 per cent - not one to three per cent as quoted by Government watchdog body, the MHRA.

Following Professor Salvatore’s speech at an annual conference, a Sling The Mesh campaigner asked if UK surgeons complied with current certifications for mesh operations.

Within days of the request the British Society of Urogynaecology (BSUG) posted on its website asking surgeons to make sure they are up to date with training and urging them to report problems to the MHRA - until now it has not been mandatory for them to do.

Dr Stefano Salvatore, president of the European Urogynaecology Association

Dr Stefano Salvatore, president of the European Urogynaecology Association - Credit: Archant

Prof Salvatore, president of the European Association of Urogynaecology (EAU), said during its annual conference that: “Meshes can be helpful but we don’t yet have the ideal material and we currently have no certification for the surgeons who perform the procedure.

“We are trying to work together with EAU offices and sections to try to create a common training programme or initiative with the European Commission, improving treatment on a European level.”


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He added that mesh: “brings a high rate of complications including pain, not just during sexual intercourse but also spontaneously.

“Also there is the case of infections, erosion, and exposure. Patients can experience shrinkage of mesh, worsening of the condition of women.

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“Pain during sex can occur not just for women but for their partners as well. This has given rise to a new term dyspareunia,” he said, which has contributed to bringing a “huge reaction against meshes from the patients themselves.”

He said mesh procedures should be performed at centres with a high number of cases to minimize complications.

For the first time firm rules were being established for mesh use, which can only be a good thing for the safety of patients, especially as complications were not always immediately clear, he said.

New developments in pelvic organ prolapse treatment may replace mesh use altogether, he added, including regenerative medicine like stimulating tissue growth, remodelling with collagen or stem cells.

• Hospital Episode Statistics for England show that in 2014/5 a total of 5,256 women had a TVT implant. Of those 450 were either fully or partially removed because of problems = 8.56% complication rate.

• The MHRA were contacted for a comment on the 8.56 per cent complication rate but after 12 days they had not replied.• In 2004 Professor Salvatore was among a group of medics who said plastic mesh should be abandoned for pelvic organ prolapse repair surgery.

The report into prolapse repair using prolene mesh showed that in some cases 63% of women suffered dyspareunia - painful sex.

• Within days of a mesh campaigner asking about the legality of mesh operations in the UK, the BSUG posted this statement on their website.

NHS Improvement (an amalgamation of Monitor & the NHS Trust Development Authority) have written to chief executives and medical directors informing them of the need for their clinicians to comply with appropriate training, adherence to clinical practice, reporting of complications to MHRA and compliance with national data requirements for all surgeons undertaking mesh procedures.

It is important that all procedures (especially tapes for incontinence and vaginal mesh for prolapse) are entered onto a national database. Together with BAUS we aim to collect all data on mesh implants for the current year (2016 to 2017).

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