Amidst the debates and arguments in terms of whether the use of transvaginal mesh devices is right or wrong, we have to remember that there are women suffering from either urinary incontinence or pelvic organ prolapse. These conditions can be extremely debilitating, embarrassing and of great discomfort to women. When a vaginal mesh device is offered, this presents the possibility of a better quality of life. But, the use of mesh implants has recently been marred with a lot of controversy, so now not only are these women worrying about their ailment but there is the added angst of undergoing the treatment - will it work or will it not?
In March of this year, Scotland produced a review of 'the Use, Safety and Efficacy of Transvaginal Mesh Implants in the Treatment of Stress Urinary Incontinence and Pelvic Organ Prolapse'. The findings are similar to the guidance provided by the National Institute for Health and Clinical Excellence (NICE) in that transvaginal mesh implant surgery can be supported on a case by case basis, but it will require a number of actions 'to ensure lessons are learnt and good and safe patient care is ensured'. In May this year, it did acknowledge the well recorded concerns around possible erosion of the device and the infections they can cause.
It is imperative that clear, precise information is available to women who have been offered a device to ensure they are part of the decision making when it comes to their treatment and care. All too often, treatment is provided and patients do not fully understand the procedures that have taken place. I was involved in a recent case where a client, in light of all the debates on mesh implants, believed that she had been fitted with a mesh to stop bleeding and considered it to be the cause of her ongoing problems; but she had not had any mesh inserted. This highlights that she had not been properly informed about any treatments that she was to undergo.
So, should the use of mesh implants be stopped? Of course, there are strong arguments for and against. The devices do appear to achieve good results when used for stress incontinence, but there seem to be long term issues when they have been used for pelvic prolapse. Over the past decade, thousands of women have had mesh implants removed. A recent report claimed that one in 15 women, who have had the most common type of mesh device inserted, later required surgery to remove them due to complications.
While the debates go on, women undergoing future mesh implant surgery need to make sure they are fully informed of its use, its effectiveness for their particular condition, and they must undergo a robust follow-up to ensure their safety in the long term.
What is clear is that the device regulation system in the UK is in dire need of overhaul. It has been playing catchup because the devices were authorised for market use before full clinical trials had been completed regarding their safety. The review by NICE is a step in the right direction, but further action is needed to protect women from the possible complications.
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