In July 2018, as part of an independent safety review led by Baroness Cumerlege, vaginal mesh procedures to treat incontinence were suspended. The surgery, which was often referred to as a quick fix, has negatively impacted the lives of 3% of the women who have undergone the procedure.

Casualty released an episode on 17 April 2021 which will help raise awareness of the complications many women have suffered following vaginal mesh surgery. During the episode, Bibi, one of the nurses’ mothers, was rushed into the A&E department after collapsing. She eventually told the medical team she had undergone vaginal mesh surgery privately for stress urinary incontinence, after the suspension of the procedure in July 2018. She had been suffering with excruciating pain in the pelvis and abdomen, had experienced issues with passing urine and had endured continuous UTIs which antibiotics were not able to fix. After a CT scan was performed, it was confirmed that Bibi had a pelvic mass which was caused by mesh erosion into her bowel. She faced having part of her bowel removed and/or mesh removal surgery.

Casualty consulted with Kath Sansom, the founder of the Sling The Mesh campaign, which she created a year after discovering women across the world had suffered similar symptoms to her following vaginal mesh surgery.

What is vaginal mesh surgery and what is it used for?

Mesh is a term used to describe different types of manufactured biological or synthetic implantable devices. In gynaecology, mesh was used for the treatment of pelvic organ prolapse (POP) and stress urinary incontinence (SUI). There are two main types of mesh used, these being transobtuator tape (TOT) and transvaginal tape (TVT).

While the mesh has been an effective form of treatment for many patients, it has also caused devastating complications for others. In a recent study, it was detailed that one in four women needed repeated surgery after TVT mesh insertion.

Complications

Most women suffering vaginal mesh complications experience the following:

  • unusual bleeding or discharge;
  • pelvic/lower abdomen pain or swelling;
  • chronic infections;
  • recurrent UTIs;
  • dyspareunia (pain during intercourse);
  • new or worsening bowel/bladder symptoms; and
  • pain in the vagina.

There are many complications which can arise from the procedure, the most common being mesh extrusion, mesh erosion or mesh exposure.

Mesh extrusion is when the mesh protrudes through the skin and tissues of the vaginal wall and becomes exposed. As a result, vaginal bleeding, vaginal discharge and severe pain can present and become a problem. Many patients also suffer pain during intercourse when suffering with mesh extrusion.

Mesh erosion occurs when the mesh erodes into the vaginal tissue or surrounding organs, often causing injuries such as vaginal or bladder perforation. This is known to be excruciating and may cause recurrent infections and UTIs.

If mesh extrusion or mesh erosion occurs, many patients are recommended further surgery. The surgery offered most commonly is the removal of part or all of the mesh, which can be a very difficult procedure. Further surgery may also be required to deal with the erosion or vaginal mesh adhesions.

Chronic pain is often linked to vaginal mesh surgery. Even with mesh removal surgery, a patient is likely to suffer from chronic pain, albeit at a lower level.

These complications often occur over time and may not materialise until years after the initial surgery was performed.

Common vaginal mesh claims

Despite the suspension of vaginal mesh surgery being in place for three years, the clinical negligence team at Penningtons Manches Cooper is still being contacted regularly by patients who have suffered complications as a result of the surgery.

In most cases, vaginal mesh should never have been inserted in the first place. Surgery should not have been performed if on assessment a patient had relatively minor symptoms of a prolapse or stress incontinence which were not overly bothersome; if tests were not performed before the surgery to determine the extent of the prolapse and/or incontinence (for example, urodynamic studies); and if conservative management had not been offered beforehand (for example, a pessary or supervised pelvic floor exercises).

There are also cases where the surgery itself may have been negligent if it was performed to a standard that was below the reasonable standard expected. An example of substandard technique is if the mesh has been inserted in the wrong place. This often isn’t identified until complications arise and a patient undergoes a scan to view the positioning of the mesh.

Many vaginal mesh patients were not warned of the risks associated with the procedure. Although not a complete list, all patients should have been advised of vaginal mesh erosion or extrusion, dyspareunia, chronic pain and the potential requirement for mesh removal surgery. If a patient was not informed of these risks, there may be a clinical negligence claim concerning informed consent.

There have been other occasions where the firm’s clinical negligence team has been instructed to deal with vaginal mesh that was inserted during another gynaecological surgery and was not discussed/consulted about prior to the operation.

Can I make a claim?

There is a three year limitation period to make any clinical negligence claim. This means a potential claimant has three years from the date of the negligence to issue a claim in the courts. However, in clinical negligence claims, the three year limitation period often starts from the date of knowledge of the issue. An example would be if a claimant underwent vaginal mesh surgery in 2015 and suffered from continued UTIs, SUI and dyspareunia, and subsequently sought advice from a GP who referred them, after some time, back to gynaecology. Following the gynaecology referral, if the gynaecologist arranged an MRI in 2020 which showed mesh erosion, the claimant’s date of knowledge would be in 2020 and the limitation period would start from this date.