Dr Naomi Saunder
Transvaginal mesh is gynaecological mesh implanted in a surgical procedure via an incision in the vagina for the management of vaginal prolapse (POP) or stress urinary incontinence (SUI). Transvaginal mesh was introduced with the aim of better success rates than achieved with traditional native tissue repairs, which have a recognised failure rates requiring repeat surgery in up to 50% of patients.
Mesh for treatment of SUI was introduced in the 1990s and was and still is the gold standard for the management. Apparent early success in the use of transvaginal mesh devices in the treatment of SUI lead to their adoption in the treatment of pelvic organ prolapse (POP).2
Early published data was relatively supportive of the safety and efficacy of the use of mesh in the treatment of POP. However, there was a considerable lag before data from RCTs became available with the first published five to seven years after the devices came into use. The prevalence and severity of problems associated with transvaginal mesh however has risen since the first Australian adverse event was reported in 2006.
There is no clear indication of how many women have had transvaginal mesh implants in Australia or how many women have experienced complications as there is no single source of information. It is thought that approximately 1% of women report significant complications however these are severe and life altering and often remain after removal of mesh leading to a senate inquiry which reported its findings in 2018.
The way forward is difficult. Management of severe mesh complications is ongoing with speciality mesh removal centres being made available in Australia. There is considerable anxiety from patients having had mesh procedures without complications wanting mesh removal. The use of mesh for SUI remains the gold standard. Where does this leave the clinician with a patient not wanting mesh – is offering an essentially substandard procedure to manage anxiety preferable? Native tissue repairs are not without complication including recurrence and vaginal pain. What do we do for women with no surgical option left? How to we ensure appropriate future governance and oversite of devices and the clinicians using them?
1/Number of women in Australia who have had transvaginal mesh implants and related matters. Mesh implants and related matters. Senate Inquiry https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_ Affairs/MeshImplants
2/ Health Issues Centre (HIC), Submission 115, p. 3.
Naomi is a general gynaecologist working in private and public practice in Hobart. Naomi trained at Mercy Hospital for Women in Melbourne before moving to Hobart. She has a special interest in pelvic floor disorders and has done advanced training at Monash Medical Centre, Melbourne in surgery for prolapse and urinary incontinence. She also has an interest in pelvic pain.