New Scientist 2018 sep

36 | NewScientist | 8 September 2018

I

N THE late 1980s, the medical industry

was looking for new ways to treat women

experiencing urinary incontinence and

vaginal prolapse, both relatively common

conditions following childbirth. At the time,

doctors suggested physiotherapy, weight loss

and other non-surgical interventions, with

complex surgery as a last resort.

When mesh implants came along,

they seemed like a simple and convenient

alternative: a flexible plastic scaffold that

took less than an hour to implant and allowed

women to leave hospital quickly and get on

with their lives. Permanent mesh implants

became standard treatment for millions of

women with these conditions.

They have proved effective in many

cases. But some women have experienced

complications, including mesh eroding

through the vaginal wall or piercing the

bladder, nerve damage and infection. The

implant can cause chronic pain, sometimes

so severe women are barely able to walk.

Tens of thousands of women around the

world have brought lawsuits. The US Food

and Drug Administration reclassified mesh

as a “high-risk” device in 2016. More recently,

Australia and New Zealand have banned its

use in some circumstances. And in July the

UK’s National Health Service suspended the use

of mesh in England for stress incontinence.

The mesh was designed to allow bodily

tissue to grow through it, so it is very hard to

remove. Sohier Elneil at University College

Hospital in London is one of fewer than

10 surgeons in the UK able to carry out the

procedure. She performed her first mesh

removal in 2005 and, since then, has been

at the forefront of the campaign to raise

awareness of mesh complications.

How bad is the situation?

It’s a crisis that’s probably unprecedented –

we still don’t know the depth of it. Worldwide,

3.7 million meshes were sold between 2005

and 2013, and we will have to monitor patients

for the next 15 to 20 years.

The complication rate is around 1 in every

10 women who receive mesh, according to

research I was involved with. And that’s just

for the first five years after implantation –

we have really limited information on longer-

term outcomes. But there are indications that

complications could be as high as 40 per cent

for mesh inserted to treat prolapse.

The complications can be serious, so why have

doctors been using the material for so long?

Originally, the complication rates were

deemed to be between 1 and 3 per cent. But

this was based on hospital data, where there

was no standardised way to record mesh

complications and removals. And these

figures didn’t consider patients who had

gone to a family doctor or pain clinic.

Why did you start removing mesh?

Women with mesh implants would often

come into the chronic pain clinic I ran with

colleagues at University College Hospital

in London. We initially focused on using

medication and other pain management

strategies but a significant group of patients

did not respond. We concluded the only

thing would be to try to remove this mesh.

Do women’s symptoms improve after the mesh

is removed?

In certain patients, things do improve and

generally women are back on track. But the

pain doesn’t always go away. There are long-

term consequences even after you have taken

the mesh out, including an autoimmune

The surgeon

fixing a scandal

The worst consequences of vaginal mesh could have been

avoided if doctors had taken women’s reports of pain seriously,

surgeon and campaigner Sohier Elneil tells Julia Brown

INTERVIEW

Protesters outside the UK Houses of Parliament

call for a halt to vaginal mesh implants

ALICIA CANTER/EYEVINE