New guidelines on the use of vaginal mesh have been met with anger by campaigners who say they do not sufficiently reflect the experiences of women who have been left with serious complications after such procedures.
The use of plastic mesh in treating urinary incontinence and pelvic organ prolapse – conditions that are especially common after childbirth – has come under intense scrutiny. While many women have the mesh implanted without problem, for others it can lead to debilitating complications including mesh cutting into organs or through tissues, intense pain and recurrent infections.
Figures previously obtained by the Guardian show that about one in 15 women who had a common type of mesh called trans-vaginal tape inserted later had it removed as a result of complications, although full removal is far from simple.
The National Institute for Health and Care Excellence (Nice) clinical guidelines for urinary incontinence and pelvic organ prolapse continue to include surgical use of mesh as one option for women with particular conditions. However, the guidelines say surgery should only be offered to women for whom non-surgical approaches have failed or been rejected. They also stress that women must be counselled about the possible complications and that both short- and long-term outcomes must be recorded in a national registry.
In the case of surgical procedures including the use of mesh, the authors write: “There is some evidence of benefit, but limited evidence on long-term effectiveness and adverse effects. In particular, the true prevalence of long-term complications is unknown.”
But campaigners say the guidelines do not do justice to women’s experiences.
Kath Sansom, of the campaign group Sling the Mesh, said: “We are appalled that despite political campaigns and the obvious suffering of many women, these guidelines are no different from what was published in 2003. They are so weak, they clear the way for the next generation of women to be harmed. We told our stories and Nice ignored us.”
The Labour MP Owen Smith, the chairman of the all-party parliamentary group on surgical mesh, criticised the guidelines.
“I am deeply disappointed that the updated guidelines appear to disregard mesh-injured women’s experiences by stating that there is no long-term evidence of adverse effects,” he said. “Thousands of women have faced life-changing injuries following mesh surgery and they must not be ignored.”
Smith said the guidelines were not clear enough that mesh should only be used when more conservative and non-mesh approaches have failed.
The authors explained that they kept mesh as a surgical option in certain cases of pelvic organ prolapse because for some women it could bring benefits.
“The committee acknowledged the public concern about the risks of procedures involving the insertion of mesh products. However, they agreed that women should not be denied effective surgical options,” they wrote. “Instead, they should be fully informed and supported by their doctor to make the right decision about their treatment.”
A similar statement was made regarding the continued availability of mesh surgery for urinary incontinence.
At present, the use of mesh for either condition, when inserted through the vaginal wall, is subject to “high vigilance restriction” – meaning many patients have had their surgery put on hold.
Dr Paul Chrisp, the director for the centre for guidelines at Nice, said that new tools to help patients to navigate the options open to them would help women make the best decision for themselves. “This might include the decision not to have surgery at all,” he said.
Baroness Cumberlege, chair of the Independent Medicines and Medical Devices Safety Review said: “Our position is very clear. Last July, we recommended, and NHS England and the Department of Health & Social Care agreed to, an immediate pause in the use of mesh for stress urinary incontinence.
“We set five conditions that would need to be met before the pause could be lifted and the use of mesh could be contemplated. Those conditions have not yet been met, and it is clear to us that it will be some considerable time before they are. This means that now and for the foreseeable future mesh should not be used to treat stress urinary incontinence either in the NHS or the independent sector.
