The vaginal mesh scandal: the medical treatment causing agony to millions of women, and how it might
Following childbirth or the menopause, many women experience issues such as incontinence and pelvic organ prolapse (where an organ such as the bladder or uterus moves out of place within the body), and a treatment known as a vaginal mesh is implanted in 10,000 women a year in the UK alone. The treatment consists of a strip of mesh implanted behind the vaginal wall to provide support. The large pores in the mesh allow tissue to grow through it for full healing.
Widely used treatments, of course, have the possibility of causing widespread disruption – and the mesh implants have recently been considered a scandal, even being referred to as “the new thalidomide” by some. Hundreds of thousands of lawsuits are being filed worldwide, and in the UK, the National Institute for Health and Care Excellence (NICE) have recommended that the implants should no longer be used to treat prolapses. In New Zealand, regulators have gone so far as to ban the mesh implant for all procedures.
These stories follow reports of millions of women experiencing severe complications – the most common include pain during intercourse and general pelvic pain, with some women experiencing pain so severe they are unable to walk. These complications are due to issues such as the mesh breaking through the vaginal wall.
10-20 % of women with the implants are estimated to have experienced severe side effects, and 19 % of those using the mesh following prolapse go on to have a further surgery. One in 15 women go on to get the mesh removed (a surgical process which takes hours and carries the risk of damaging organs such as the bowel), and in one survey a shocking 59 % of patients reported that their initial issue was not fully resolved. The Medicines and Healthcare Products Regulatory Agency, however, estimates the side effect rate at just 1-2 %.
It is worth noting that there is a difference between the two uses – considering stress incontinence, issues have been less widely seen and NICE has not recommended its used is stopped, the general consensus being that it is effective and carries low risk. For prolapse cases, NICE stated that evidence for long-term suitability was “inadequate in quality and quantity” – subsequently recommending that for this condition, mesh is used only for research. The difference may be related to the amount of mesh used – in prolapse cases, much bigger areas of mesh are used than the thin strips supporting the urethra to tackle incontinence.
While banning or reducing the use of mesh implants offers a way to avoid such cases, it also removes what was in some instances a viable treatment option – so some researchers have been considering how else the issue could be alleviated. Right here at the University of Sheffield, in the Department of Materials Science and Engineering, researchers have spent seven years investigating alternative mesh materials. Commercial meshes are manufactured with large pores from polypropylene, which is relatively rigid. The material developed at Sheffield is instead made from polyurethane (PU): a more flexible material which has been shown not to cause inflammation, and is spun into a much finer mesh and layered to mimic human tissue. As well as being manufactured differently, the meshes have had the oestrogen hormone introduced. This addition appears not to affect the other properties of the mesh, and stimulates cells to produce new tissue – ultimately speeding up the healing process.
With adequate testing, trials, and approval, this solution provided by the University of Sheffield has the potential to improve the lives of millions of women – something we can surely all be proud of the university for.