Women’s health support groups have been praised for raising awareness of pelvic mesh risks, according to a leading gynaecology surgeon, who admitted the number of women suffering was probably higher than Government figures reflect.
Philip Toozs-Hobson, treasurer of the British Society of Urogynaecolgy and former clinical director of gynaecology at Birmingham Women’s Hospital, said: “Complications should be reported to the MHRA and both surgeons and patients have a responsibility to do this.”
Groups like TVT Mum, TVT Info, Scottish Mesh Survivors and Sling The Mesh meant that: “Surgeons are starting to think about mesh more carefully which is a good thing,” he said.
And while he still thinks there is a role for tapes for incontinence, and a far more limited one for mesh kits for pelvic organ prolapse, the changes in how people think about surgery is good.
“We all need to pay care and attention to who, when and how we operate,” he said.
“There is sometimes a recourse to surgery too quickly nowadays - this often happens when you make an operation simpler it changes the goalposts and the threshold to operate changes and we have seen this with gall bladder surgery.
“I would suggest surgery may be offered too easily to too many women.” he said.
“I probably do around 40 mesh tapes a year and around 10-15 other procedures.
“I have externally reviewed a number of other cases and would estimate I would have been extremely cautious in operating on 80 per cent of them.
“I see surgery as a last resort and would always consider physiotherapy first as per NICE guidelines.
“You don’t know how individual people’s metabolism behave as to why some suffer erosion and others don’t, but certainly we would recognize that patients with pre-existing pain for example and that those on certain medications such as steroids, with diabetes or recognized immunological conditions are at greater risk of doing badly” he said.
“There’s no such thing as a free lunch – if somebody has cancer and they are left with a colostomy bag after a tumour removal, but are alive then that it is a good outcome, but if a woman goes for treatment for SUI and comes out with a raft of problems then that is not a good outcome.
“You have to look at lifestyle, just how much is this affecting a woman and offer everything before mesh.
“Risks need properly explaining, there is an argument that the pre-op talk now takes longer than the operation, but it is important a woman knows what she is opting for.”
He added that mesh kits have largely been withdrawn by the companies and many surgeons will be cautious about the use of these in line with the recent SCENIHR, Scotland and NHSE reports.
He added mesh sheets were virtually impossible to fully remove as they were designed to be a permanent device, whereas some tapes were more amenable to more complete excision.
When it came to problems he said surgeons needed to be aware that reversible complications can occur including what he said were rare complications like women who wake in terrible pain who may need the tape removing.
“There is certainly a 48 hour window, some surgeons say 10 days, of opportunity to remove a tape safely before it is embedded and that is something that needs to be recognised by more doctors when things are obviously not right,” he said.
“Trust in the medical profession remains high and as surgeons we must make sure the implications of surgery are very clear to our patients because the ramifications to the small percentage of a woman suffering complication are potentially huge.
“There is now a vast amount of data in the BSUG database and many surgeons will now use this to show their own data rather than relying solely on generic information leaflets.
“Additionally the British Society of Urogynaecology is working hard at trying to generate useful audit data to help inform gynaecologists on outcomes based on the nearly 20,000 cases reported on their database,” he said and added the CE marking system for medical devices was a concern as it related to manufacture rather than clinical data, because the system only checks quality assurance of the manufacturing and not quality assurance of the product.
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