A new study from Canada reports women with complications from a mid-urethral mesh sling (MUS) procedure have an elevated risk of new onset depression and thoughts of suicide when compared to women who do not have complications.
Image: Pain by Jade R
The MUS remains the standard treatment for stress incontinence (SUI), used in about 90% of procedures. Doctors still have no way to determine who will suffer from a complication, thought to range from 3 to 30 percent.
The MUS can be placed transvaginally through the retropublic space or the obturator space. The latter is thought to present an increase in complication rates.
This large study of 57,611 women was conducted by researchers from Western University Department of Surgery in London, Ontario, the Department of Epidemiology and University of Edmonton. Dr. Blayne Welk, MD, a urologist at Western University, is the lead researcher.
The study is published in the January 9, 2019 Journal of the American Medical Association (JAMA).
Dr. Welk told The Star that while the vast majority of women do quite well after surgery, those who do have complications face a challenge.
“They can be serious and they can be life-changing in some cases.”
Altogether the 57,611 women received a mid-urethral sling from 2004 to 2015. Among this group, nearly 1,586 needed to undergo surgical revisions or removal due to complications.
Those who had to undergo a surgical correction had a significant - 21% - increased risk of depression.
Women under the age of 46 had a 38% increased risk of depression.
Interestingly, for women older than 66, researchers found no significant difference in depression risk and had no greater risk of self-harm or suicide while younger patients, 46 to 66, had a 2.4 greater risk of self-harm. Patients under the age of 46 had a 1.7 fold increased risk of self harm behavior such as attempted suicide that led to an emergency room visit or admission to a psychiatric hospital.
Polypropylene vaginal mesh can affect sexual intimacy and make sex painful.
Welk told The Star “The big challenge with these complications is that in some cases they can be very hard to correct completely, and then the second thing is there’s an element of decisional regret for a lot of women who have these procedures done. I've seen a lot of patients referred with complications and a lot of them, they were quite emotional about it and described a long journey trying to find someone to evaluate them and help them with the complications.”
Another study Dr. Welk led in 2015 found that over a ten year period of time, about three percent of Ontario women needed a corrective surgery, either a revision or removal.
Four women at AUGS
Many readers of Mesh News Desk have told us they were not told about the mesh complication rate, had no true informed consent, and in some cases did not even know they were having mesh implanted. After reporting a complication, some women are turned away from their implanting doctor, essentially fired, or told the pain is in their head.
Dr. Welk agrees, women need support from doctors who need to better recognize mesh injuries.
“I think this sort of reinforces the message that we need to make sure women do have timely and appropriate evaluation for complications if they do occur and that people keep in mind that they might need support for psychiatric illness that may be occurring at the same time.”
British Columbia resident Noni Wideman is a mesh implant survivor who is very familiar with the emotional trauma over mesh. In her LinksonMesh Facebook page she discusses the emerging science about the body’s reaction to polypropylene and takes to social media to share in the mesh injured community.
She tells MND, she feels let down by the study.
“I was dismayed that he failed to consider the depression and suicidal thoughts of women suffering painful, crippling life-altering and threatening complications who have not had their mesh complications accurately diagnosed and not found skilled mesh removal specialists to remove their mesh. Pre-mesh removal surgery, when hope and help are not offered, is more frightening, more depressing than when mesh removal surgeries have been done.”
“Post-surgery there is always hope for healing. Without skilled intervention and validation of pain and sickness, without mesh removal offered to them, the women I have talked to are voicing suicidal idealizations more than those who have had surgeries and mesh pain isn't as complete as the women expected or hoped for. The study failed to tell the whole story. the study failed to encompass the women waiting for validation, waiting for mesh removal approvals with verified skilled surgeons.”
With the news about lawsuits and settlements, women are increasingly having doubts about using a mid-urethral mesh sling (MUS) as an incontinence treatment. Some doctors soften the pitch for a mesh medical device by telling women it is a "new" mesh. It is still made of polypropylene as it always has been with some variation in pore size in some cases.
Women continue to be implanted. ###
In this Mesh News Desk podcast, Dr. Donald Ostergard talks about how to find a doctor to do pure tissue repair rather than use polypropylene mesh, tests, and treatments for SUI.
Jan Urban has been reaching out online to other mesh-injured women for a decade trying to raise awareness about mesh injuries.