Australian Mesh Recommendations Mostly Welcomed

Australian Mesh Recommendations Mostly Welcomed by NZ Doctors

Yesterday’s findings from the 7-month-long Australian Senate Committee Inquiry into transvaginal mesh have been met with widespread support from New Zealand UroGynaecologists …despite concern over one recommendation which would, if adopted here, significantly limit a highly successful surgical option for urinary incontinence.

Senior New Zealand members of the UroGynaecological Society of Australasia(UGSA) say they acknowledge and fully accept many recommendations from the extensive Inquiry report, including the assurance that all women are fully informed and have a good understanding of any potential side-effects from surgical mesh prior to their procedure; that a Centre of Excellence be established in Australia to monitor transvaginal mesh use and complications; and for the introduction of central data collection and on-going audit of all mesh use for women.
However, one recommendation, that the implantation of all transvaginal mesh products should only be undertaken as a last resort, is being met with caution and concern by doctors treating women for urinary incontinence.

While supportive of last year’s Australian TGA decision to remove transvaginal mesh use for women with prolapse due to uncertainty over the risk/benefit balance, many New Zealand urogynaecologists say limiting use of the safest and most effective surgical treatment for urinary incontinence, the mid-urethral sling, would be a backward step for the 1 in 3 New Zealand women who suffer from incontinence, forcing doctors to revert to more traditional, riskier surgical methods.

“It’s very clear and highly regrettable that some women have been harmed by mesh surgery and this is obviously an area where we must focus our efforts in the future” says Christchurch’s Dr John Short, Vice-Chair of the UGSA. “Any surgery has the potential to cause complications and of course non-surgical treatments such as physiotherapy should be considered as first line treatment. However, data clearly shows that the bulk of mesh complications have occurred for vaginal prolapse. The rate of complications with mid urethral sling mesh for incontinence is much, much lower and limiting its use would be a disservice to patients”.

The minimally invasive MUS has been used in Australia and New Zealand since 1998. It’s been extensively studied for almost 2 decades in over 2000 scientific publications and is recommended by the Royal Australian and New Zealand College of Obstetrics and Gynaecology as highly effective, with fewer adverse outcomes than other available continence surgeries.

A Middlemore Hospital study following 540 women operated on using MUS trans-vaginal tape between 2010-2016 showed less than 4% suffered post-operative complications. In total, seven women (1.8%) experienced difficulty passing urine while ten (1.85%) experienced sling exposure.

“Both of these complications were readily fixed with minor follow-up procedures” says Middlemore Hospital Urogynaecologist Dr Lynsey Hayward. “

Limiting the use of mid urethral slings would force doctors to rely on more traditional types of surgical repair; using either a patient’s own tissue (known as a fascial repair) or a procedure called a Burch Colposuspension, where permanent stitches were used to lift up the neck of the bladder. However, both are surgically complex, involving a lengthy hospital stay and post-operative recovery, with a greater risk of bleeding, wound infection, difficulty in passing urine and subsequent prolapse.

“Reverting to older, more traditional means of repair would be a backward step, exposing women to risks such as bleeding, thrombosis and infection” says Dr Hayward. “It would turn what’s currently a simple day-stay procedure into a multi-day hospital stay, with six weeks off work to recover. I would probably be unable to treat around one third of the women I treat now, due to factors such as obesity, diabetes, other medical conditions and age, as these women are less able to tolerate lengthy abdominal surgery”.

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