Vaginal mesh surgery comes under scrutiny

Posted: 19/04/2017

Emma Beeson, an associate in the Penningtons Manches clinical negligence team, acts for a number of women who have received negligent treatment for issues such as incontinence and pelvic organ prolapse. She knows all too well the devastating effects that vaginal mesh implants can have on women. Yesterday, BBC News reported that more than 800 women in the UK are taking legal action in respect of mesh implant surgery and numerous women then discussed their stories on the BBC2 Victoria Derbyshire programme.

In light of the recent media attention, Emma Beeson discusses her experience of handling successful claims for this type of surgery: “Yesterday’s discussion on the Victoria Derbyshire programme regarding concerns relating to the use of vaginal mesh came, sadly, as no surprise and it was very upsetting to hear the stories of so many women who were brave enough to talk about the devastating impact the use of mesh has had on their lives.

“So much of what the women spoke about yesterday resonated with things my clients have said to me. Comments such as:

'My husband is like my carer.'

'I can’t have sex anymore.'

'The tape had eroded and I required numerous operations to remove it.'

'I was never told the risks by my surgeon.'

'I never knew there were more women suffering like me.'"

Emma believes that it is this last comment that is the most pertinent because this is not something that has only affected a small number of women; there are hundreds of women who have been affected and possibly hundreds more because some women are too afraid to speak out and seek help and advice.

A number of her clients had been suffering in silence for years because they were either too afraid to seek help or, after speaking to their doctors, were told that their problems were either unrelated to their mesh operations or they were simply making them up.

Emma and her colleague, Elise Bevan, are currently acting for a number of women who are pursuing claims against Frimley Health NHS Foundation Trust for the negligent care they received from consultant gynaecologist, Jayne Cockburn. After having raised awareness of these claims they are now also acting for a number of women throughout the country who have received potentially negligent care at other hospitals.

The women who were treated by Miss Cockburn were informed by the hospital that there were concerns that the problems they were reporting were linked to their surgery after an internal investigation was carried out. After having been told that the care they received was negligent, these women sought Penningtons Manches’ clinical negligence team’s advice and are now pursuing claims for the devastating effect this surgery has had on their lives.

“These women initially presented with problems such as minor stress incontinence and pelvic organ prolapse, and in a number of cases they underwent inappropriate surgery which included the insertion of vaginal mesh as part of a prolapse repair or the insertion of a transvaginal tape for incontinence.” Emma explains: “These women were not warned of the risks associated with this surgery and, in some cases, the women were completely unaware that the mesh and/or tapes were used.

“My clients now have problems with pain during sex, constant urinary tract infections, they have overactive bladders which require treatment by way of Botox injections, they suffer from constant pain and have required numerous operations to remove the mesh and deal with erosion.

“What I think is important for people to understand is that there are different types of vaginal mesh and often the terminology used in the media confuses these different types. It is important when I am assessing a potential claim to understand what type of mesh was used. It is equally important for women to understand what type of mesh the doctors are proposing to use and what they are consenting to.”

Mesh which is usually made from synthetic polypropylene is intended to repair damaged or weakened tissue.

Women can suffer a pelvic organ prolapse which is where a pelvic organ such as the womb or bladder drops from its normal place. It can push against the wall of the vagina or can sometimes protrude out from the vagina. This happens because the muscles which hold those organs in place become weak or stretched, which often occurs following childbirth. Mesh can be used as part of surgery to keep the organs in place.

Mesh can also be used to treat stress incontinence, but in this scenario it is in the shape of a sling and is sometimes referred to as a transvaginal tape. Stress incontinence is the involuntary loss of urine from the bladder when it comes under stress. It happens because the pelvic floor muscles which support the bladder become weak. The sling/tape is used to support the bladder neck so that when the bladder comes under stress during coughing or sneezing, the urethra can remain closed with no accidental release of urine.

Whilst a large number of women undergo these surgical procedures with no complications, some women have suffered life changing consequences as a result of having the mesh and tapes fitted. Emma says: “These women have been brave enough to speak out and share their experiences in support groups such as 'Sling the Mesh' so that other women can recognise that they are not alone in what they are going through.

“As a result of these brave women speaking out about their stories, in 2014, the health secretary in Scotland asked health boards to suspend the use of vaginal mesh implants. An independent review took place and the report was published on 27 March 2017.”

The report recognised that mesh procedures do carry a risk of serious complications which are in some cases life changing and which cannot be corrected. However, it did note that for most women such complications do not occur. The findings of the report also concluded that women should be offered all available treatments and must have access to advice and information that allows them to make an informed choice.

The release of this report has obviously sparked further discussion and attention to the issue of whether or not the use of mesh surgery should be continued in the UK.

On this issue, Emma comments: “Some women are of course deeply troubled by problems such as incontinence which can disrupt their daily lives, affect their relationships and cause them embarrassment. Women who suffer from pelvic organ prolapses can often suffer from severe dragging pain and discomfort which stops them from working and carrying out their normal activities. In some of these cases, surgery is an appropriate option and can often lead to the successful resolution of symptoms with little or no complications. For these women, it could be argued that the use of vaginal mesh should not be banned as it has resolved their symptoms and improved their lives for the better.

“Any woman considering undergoing this type of surgery should be aware of both ends of the spectrum.

“As a clinical negligence lawyer, this is what I am concerned with. Has a patient been given all the information they need about the risks and options available to them such that they can make an informed choice and give their full informed consent? Were appropriate investigations carried out to confirm that the use of a transvaginal tape was justified and necessary?

“My colleague Elise Bevan and I spoke at the Women of the World Festival last month at the Southbank Centre in London on the lessons we have learned in dealing with these cases and to empower women to not be afraid to talk about issues such as incontinence and prolapse. Through talking about these issues we learn more about the risks associated with these procedures and alternatives that can be tried instead of surgery. All too often my clients say to me: ‘I trusted my doctor, I didn’t know what the procedure was and wasn’t aware of the risks. I assumed that if the doctor said I needed surgery that I should have it and I didn’t think to ask what alternatives there might be.’

Emma adds: “The key issue is that women should be aware that these procedures do come with risks. The mesh can erode, it can lead to the need for more extensive surgery to remove the mesh/tape, it can cause pain, it can cause constant urinary tract infections and pain during sex. Women should also be aware of the alternative options there may be, such as pelvic floor physiotherapy and lifestyle changes such as losing weight and changing drinking habits. They should also be aware of the option to choose to do nothing. This is a voluntary procedure and is not mandatory life-saving surgery. The important thing is having a choice and knowing the risks.

“I am pleased to see that people are starting to talk about this issue more openly and honestly and I hope it will give the strength and courage to those women who have been suffering in silence to come forward and seek help and advice if they need it. For those women who are concerned that they have received negligent treatment, they should be aware that there is a time limit of three years from the date of negligence for pursuing a clinical negligence claim, unless there is a later date of knowledge. For this reason, I encourage any woman who has concerns to come forward and seek advice as soon as possible.”

If you have any concerns regarding treatment you have received for stress incontinence, prolapse or any other form of gynaecological procedure, please contact a member of our specialist team for free on 0800 328 9545.

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