NHS Digital published it’s review into the treatment of pelvic organ prolapse and stress urinary incontinence on 17 April 2018. The review had been requested by Jeremy Hunt earlier this year in response to concerns over the reports of significant mesh related complications and which we commented on previously here.
The report separates the statistics related to incontinence and prolapse procedures and makes very interesting reading.
The review has confirmed that since 2008 there have been approximately 100,000 surgical procedures to insert mesh tapes to treat urinary incontinence but that these have significantly reduced in recent years with nearly a 50% drop in 2016/17 compared to 2018/09. Approximately 7-10% of all tapes inserted are removed after 30 days. This seems to be consistent with previously reported failure rates for TVT/TOT treatments and confirms that mesh tapes are still by far the most popular surgical treatment for stress incontinence when compared to traditional non-tape surgery.
By comparison, mesh surgeries for pelvic organ prolapse have much lower figures with only 27,016 reported mesh insertions for the same period. Whilst the proportion of mesh removal surgeries was lower (1.8 patients per 1000) in 2015/16, importantly the number of reported complications and treatments in outpatients was higher with 46 out of 100 being seen in outpatients. A review in outpatients after 30 days is a general measure of a patient being unhappy with her outcome. This confirms the anecdotal reports that problems with mesh in pelvic organ prolapse are high but that removal is difficult due to the nature of the mesh and how it works – signifying that treatment options are very limited.
Overall this review will reinforce the view that mesh in the use of pelvic organ prolapse is problematic but that there are clearer merits in it’s use in the treatment of stress incontinence. The rapidity of this review is to be welcomed, however, it is now for the Department of Health, National Institute for Clinical Excellence and the Medicines Healthcare Regulatory Authority to give clear guidance on the use of mesh going forward so that patients can be fully informed and understand the risks that they face.