Today’s recommendation by the Australian Senate Committee Inquiry that implantation of all transvaginal mesh products should only be undertaken as a last resort has been met with bewilderment and concern by doctors treating Australian and New Zealand women for urinary incontinence and pelvic floor conditions.
The Urogynaecological Society of Australasia (UGSA) says this recommendation affects women’s options for care by limiting access to the safest and most effective surgical treatment for urinary incontinence, the mid-urethral sling or MUS. "This decision is one of the most retrograde steps in the history of modern surgery" says UGSA Chair Dr Jenny King. "It simply disregards sound scientific data".
UGSA states lightweight, minimally invasive mid urethral slings have been used in Australia and NZ since 1998. They have been extensively studied for almost two decades with over 2,000 scientific publications. The mid-urethral sling is supported as the operation of choice for stress urinary incontinence by every --- women’s health and pelvic floor society in Europe, the United Kingdom and the USA. It is important to note that the US FDA statements on safety concerns over transvaginal mesh do not include mid urethral slings and the Australian TGA has continued to support the inclusion of these products on the Register of Therapeutic Goods.
Just this week The Australian Commission on Safety and Quality in Health Care (ACSQH)released the hospital credentialing guidelines for MUS stating "There is robust evidence nationally and internationally to support the use of the traditional mid urethral sling for stress urinary incontinence in appropriate cases." The Royal Australian and New Zealand College of Obstetricians and Gynaecologists also recommends the MUS as it is highly effective in the short and medium term with fewer adverse outcomes than other available major continence surgeries. "MUS have been clearly shown to be safer and more effective with a lower complication rate than our previous continence procedures", says Dr King.
UGSA believes the way forward lies in rigorous safeguards including ongoing audit, long term monitoring, careful surgical training and research with thoughtful patient selection and counselling. These recommendations have also been made by the ACSQH and many are included in the Senate recommendations. All will improve care for our patients.
But UGSA also makes a plea for sensible and accurate discussion of these issues. So many women have been made unnecessarily anxious by the emotive and scaremongering coverage of transvaginal mesh that they are now waiting for something to go wrong or are just too frightened to consider a treatment which will be of real benefit.
Our task now is to care for those women with ongoing problems and to continue to advance our treatments for those women still suffering with incontinence and pelvic floor weakness. Often the best treatment option will be a mid urethral sling – women must be able to make that choice.
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