The TVT or TVT-O method for treatment of stress urinary incontinence, widely-favoured in England, has come under scrutiny in the US and Canada.
In the England, insertion of the TVT/TVO Mesh for treatment of stress urinary incontinence (SUI) and pelvic organ prolapse is considered the 'gold standard' treatment by leading urogynaecologists.
What is TVT?
Trans-vaginal tape, or TVT, is a form of sling that is inserted to support the urethra and prevent leakage. A TVT Obturator, or TVT-O, is a specific design of sling. Once implanted, these devices are intended to remain in place permanently.
Vaginal mesh complications – the North American studies
Studies recently undertaken in the US and Canada suggest that, in general, mesh insertions demonstrate 'excellent results and minimal complications. '
However, the TVT procedure is not without concerns. Many patients have complained of an array of often serious problems, including chronic pain, urethral fistula, significant voiding dysfunction, mesh erosions leading to exposure into the vagina or urethra, bladder problems and sexual difficulties.
The standard treatment for these difficulties is to undergo a second procedure to remove the mesh, although this can cause further complications, not to mention huge emotional and physical distress.
Vaginal mesh worldwide
The severity and extent of the issue is highlighted in the US and Canadian study, which observes that:
'In the United States, more than 50,000 women have joined class action lawsuits for transvaginal mesh complications resulting from SUI and prolapse procedures.'
In Scotland, the use of vaginal mesh has been suspended pending an independent inquiry. In the USA, class actions have been brought against manufacturers of TVT and TVT-O products and many mesh kits have been withdrawn from the market. Use of TVT has also been suspended in Australia.
A leading gynaecologist practising in England, Christine Landon, has expressed concerns that many of the problems experienced by women with TVT implants may be going unreported. She stresses the importance of thorough reporting as a crucial way to ensure that use of mesh products in the future is safe. Ms Landon has written an in-depth article that sets out a thorough analysis of the effects of mesh in the English context.
Are there any other options?
Many women undergoing the TVT or TVO procedure will have spent years prior to the operation undertaking various treatments, such as pelvic floor exercises, nerve stimulation or medications. In many types of surgery, doctors would be expected to offer alternative options for patients, although in the case of SUI, doctors can recommend mesh insertion as the main or only permanent option, provided that all conservative treatment options have been explored and exhausted first.
Under the guidelines issued by the Department of Health, anyone undergoing this type of surgery must give full, and genuine, consent. This must follow an explanation of the risks and likely complications of the surgery, alongside an assessment of the likely benefits to the patient.
The decision to receive this serious and permanent treatment cannot be taken lightly, and it is a doctor's responsibility to ensure that a patient is given enough information to make a proper choice.