Study Supports Mesh Surgery for Incontinence But Not for Bowel or Bladder Prolapse

MedicalResearch.com Interview with:
Dr Rachael Wood PhD

Consultant in Public Health Medicine – women and children’s health
NHS National Services Scotland
Information Services Division
Edinburgh

MedicalResearch.com: What is the background for this study?

Response: Mesh surgery for female stress urinary incontinence and pelvic organ prolapse is currently controversial.

Mesh surgery was introduced to overcome recognised limitations of traditional, non-mesh, surgery for these conditions, in particular extensive surgery and long hospital stays for incontinence and high failure/recurrence rates for prolapse. Mesh surgery may therefore offer additional benefits over traditional surgery. Mesh surgery may also carry additional risks however, with patient advocacy groups highlighting cases of severe, long term, mesh-related complications in some women who have undergone mesh surgery.

We therefore used routinely available, population based hospital discharge records from Scotland to identify women having mesh and non-mesh procedures for incontinence and prolapse. We then followed the women up for up to 5 years to assess how often they were readmitted for complications or further incontinence or prolapse surgery.

MedicalResearch.com: What are the main findings?

Response: Our findings for incontinence and prolapse are different.

Regarding surgery for prolapse of the bladder or bowel, we found that mesh surgery was less effective than non mesh surgery (higher rate of repeat prolapse surgery) and associated with substantially (x2-3) higher long term complication rates.

Regarding surgery for prolapse of the vaginal vault, we found no difference in repeat surgery or complication rates following non mesh surgery or surgery involving transvaginally- or abdominally-placed mesh.

Regarding surgery for incontinence, we found that mesh surgery was as effective as non mesh surgery (specifically open colposuspension) and long term complication rates were similar. Further, we found that mesh surgery carried a lower risk of immediate complications (at the time of the initial surgery) and a lower risk of inducing prolapse.

MedicalResearch.com: What should readers take away from your report?

Response: Mesh surgery should not be recommended as first line treatment for prolapse of the bladder or bowel.

Current evidence supports the use of mesh surgery in incontinence.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Further research on long term complications following mesh and non –mesh incontinence surgery would be beneficial.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Adverse events after first, single, mesh and non-mesh surgical procedures for stress urinary incontinence and pelvic organ prolapse in Scotland, 1997–2016: a population-based cohort study
Morling, Joanne R et al.
The Lancet , Volume 0 , Issue 0 ,
Published: 20 December 2016
Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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