Vaginal mesh: insufficient new guidelines, activists say | Society



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New guidelines on vaginal screen use have been received in anger by activists who say they do not sufficiently reflect the experiences of women who have had serious complications following these procedures.

The use of a plastic screen in the treatment of urinary incontinence and pelvic organ prolapse – conditions that are especially common after childbirth – has been subjected to intense scrutiny. While many women have the screen implanted without problem, for others it can lead to debilitating complications, including knitting in organs or tissues, severe pain and recurrent infections.

Figures previously obtained by The Guardian show that about one in 15 women who had a common type of mesh called trans-vaginal tape inserted subsequently removed as a result of complications, although total removal is far from simple.

Clinical guidelines from the National Institute of Excellence in Health and Care (Nice) for urinary incontinence and pelvic organ prolapse continue to include surgical use of the screen as an option for women with specific conditions. However, the guidelines say that surgery should only be offered to women for whom non-surgical approaches have failed or been rejected. They also emphasize that women should be counseled about possible complications and that short- and long-term results should be recorded in a national registry.

In the case of surgical procedures, including screen usage, the authors write: "There is some evidence of benefit, but limited evidence on long-term efficacy and adverse effects. In particular, the true prevalence of long-term complications is unknown. "

But activists say the guidelines do not do justice to women's experiences.

Kath Sansom of the Sling the Mesh campaign group said: "We are shocked that, despite the political campaigns and the obvious suffering of many women, these guidelines are no different from those published in 2003. They are so weak that they open the way. next generation of women to be harmed. We told our stories and Nice ignored us.

Labor deputy Owen Smith, chairman of the all-party parliamentary group in surgical drapes, criticized the guidelines.

"I am deeply disappointed that the updated guidelines seem to disregard the experiences of women with malicious injuries, stating that there is no evidence of long-term adverse effects," he said. "Thousands of women faced life-changing injuries after knit surgery and should not be ignored."

Smith said the guidelines are not clear enough for the mesh to be used only when more conservative and non-knit approaches fail.

The authors explained that they maintained the mesh as a surgical option in certain cases of pelvic organ prolapse, because for some women this could bring benefits.

"The committee acknowledged the public's concern about the risks of procedures involving the insertion of knit products. However, they agreed that women should not have denied effective surgical options, "they wrote. "Instead, they should be fully informed and supported by their doctor to make the right decision about treatment."

A similar statement was made about the continued availability of mesh surgery for urinary incontinence.

Currently, the use of the screen for any condition, when inserted through the vaginal wall, is subject to "high restriction of surveillance" – meaning that many patients have had their surgery suspended.

Dr. Paul Chrisp, director of the policy center in Nice, said new tools to help patients navigate the options open to them would help women make the best decision for themselves. "This may include the decision not to have surgery," he said.

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