Mesh implants for vaginal prolapse and incontinence have been in use since the early 1990s. Over 120,000 women have had these vaginal mesh implants surgically implanted in the last ten years in the UK.
For the majority of these women, vaginal mesh surgery has been successful, with good long-term results. Some women however, have experienced complications including erosion of mesh into the bladder or vagina, or mesh related pain.
If you’ve had vaginal mesh implant surgery and you’re now experiencing complications, or you’ve heard about the possible risks, you’ll be understandably worried. You may even be wondering if it’s possible to have your vaginal mesh implant removed.
Vaginal mesh implants have been used to help treat vaginal prolapse and stress urinary incontinence.
A vaginal prolapse is when an organ from the pelvis, most commonly the bladder, but also the bowel or cervix, pushes down, or prolapses, towards the vagina. It can result in the organ protruding through the vagina.
Stress urinary incontinence is the unintentional leaking of urine, and happens most commonly when coughing, laughing or exercising due to the increased abdominal pressure on the bladder. Women who have given birth are more likely to have stress incontinence, as pregnancy and childbirth can cause the muscles to weaken.
Traditional operations to repair vaginal prolapse or stress incontinence, used suturing techniques alone, but were prone to (long term) failure as the tissue being repaired (sutured) was the same tissue that had failed in the first place.
During the 1970-1990s, procedures were developed which supported these repairs with polypropylene mesh (surgical mesh). The mesh increased success rates and reduced the risk of recurrence of prolapse or incontinence further down the line.
Although mesh repairs have been very successful in treating the majority of women with prolapse or incontinence, it has gradually come to light that a small number of women may develop problems related to the mesh implants.
In the last decade, there have been multiple medical reviews into the use of vaginal mesh implants. The data is still being gathered together, but it’s estimated that around 3-5% of women who have had a vaginal mesh fitted have needed further medical treatment following their surgery.
Complications with vaginal mesh implants include pain that sometimes significantly impacts on quality of life, and mesh erosion.
Mesh erosion is where the mesh can be felt in the vagina. The mesh can also erode into the bladder or urethra (water pipe). More rarely mesh erosion can involve the bowel.
Pain around the mesh in the vagina can cause painful sexual intercourse (dyspareunia) or pain that spreads to the pelvis or thighs.
Several independent reviews have been carried out by a number of medical bodies including Scottish Public Health group, NHS England and the Medicines and Healthcare products Regulatory Agency, or MHRA.
The MHRA review was completed at the request of the Chief Medical Officer, Professor Dame Sally Davies after mesh problems became the subject of medico-legal process in the United States, and the issues highlighted in the wider media.
Patient support groups have also been very active in giving women affected by vaginal mesh implant complications a voice. They’ve called for more regulation around the procedure.
In July 2018, Baroness Julia Cumberlege ordered that the Department for Health and Social Care (DHSC) pause all vaginal mesh implant surgery until further data and expert opinion has been assessed.
There are now strict guidelines in place for doctors, consultants and surgeons specialising in vaginal mesh surgery implants and mesh removal across the UK.
Other guidelines being developed, will in future mandate that complex surgery can only be carried out by accredited specialists, working in multidisciplinary teams. Outcomes will be monitored closely and regulated by the NHS.
Women experiencing problems with vaginal mesh implants have been widely reported in the press.
We understand that women will be nervous and concerned about the impact their vaginal mesh may have on their body and their lives.
Here at the King Edward VII’s Hospital in London, we have set up The Vaginal Mesh Centre specifically for the assessment, medical and surgical management of vaginal mesh, The service is led by expert surgeons and clinicians who are all members of the Pelvic Floor multidisciplinary team at University College Hospital, London.
Surgery for vaginal mesh removal involves removing the mesh through the vagina under a general anaesthetic.
Each woman is different. Some women may also require the remaining mesh to be removed via a small surgical cut to the abdomen or thigh.
Most recently, our specialists have been developing combined operating techniques using minimally invasive (keyhole and vaginal) surgical procedures to deal with the complications of vaginal mesh implants, and their removal.
Your surgeon will discuss your case with you on an individual basis.
No surgical procedure is without its risks but if your mesh is causing you considerable pain or has eroded, specialists at the Vaginal Mesh Centre will be able to talk you through the procedure and what it will mean for you. Your specialist will discuss what options you have, and the support you will be given to help prevent problems arising afterwards.
The Vaginal Mesh Centre multidisciplinary team adheres to the strict guidelines set out by Baroness Cumberlege and the National Institute for Health and Care Excellence (NICE), for the removal of mesh implants.
Your first point of call should be your GP, to discover what options you may have available.
If you wish to be seen privately, the vaginal mesh centre coordinator will guide you to the most appropriate consultant in the multidisciplinary team to assess your needs quickly and efficiently
If you’ve experienced problems with your vaginal mesh implant, you can report your concerns directly to the MHRA.