Mesh surgeries paused since 2018 despite new guidelines

A CUMH consultant is calling for an end to the national pause on use of vaginal mesh to treat stress incontinence in Ireland, its been in place since 2018 despite new guidelines existing for 14 months now for safe use.

A 'temporary' pause on vaginal mesh surgeries has still not been lifted six years after it was introduced, despite new guidelines on using mesh for stress incontinence which were published in January 2023.

One Cork consultant estimates they now have “hundreds of women” waiting.

The pause began in July 2018 when women highlighted serious complications including mesh erosion which left some with chronic pain.

A review of its use for stress incontinence and pelvic organ prolapse followed recommendations by then chief medical officer Dr Tony Holohan.

However Dr Suzanne O’ Sullivan, obstetrician urogynaecologist at Cork University Maternity Hospital, said these have been acted on. 

“We have hundreds of women in Cork waiting,” she said.

“Most of our patients want to wait because they know the people who it worked so well on, and I’m with them on that.” 

She was involved in creating guidelines for treating stress incontinence. 

These have expanded consent processes and say only specialist surgeons would carry out mesh procedures.

Ireland and the UK are the only countries which still have this pause, she said.

Australia stopped use of some meshes for certain procedures but mid-urethral slings for stress incontinence continues.

Dr O’ Sullivan is Cork mesh complications service lead, and said those women have “genuine severe problems for years” linked to mesh.

“We know multiples of thousands of procedures were done nationally before 2018 –and fully acknowledging the impact on all women who have suffered a complication. If you look at our real complication rate compared to international numbers – it has been relatively low in Ireland, thankfully,” she said.

One Cork mother, 46, who has incontinence since her first child was born nine years ago, called for the pause to be lifted.

“I’m unable to just live my life, to live the way I’d like to. My life has also been put on pause,” she said.

“I want to run with my kids. I want to coach them in GAA and go down a waterslide with them on holidays. But that is all impossible now.” 

Non-surgical options have not worked, she explained.

However Terri Martin, co-ordinator of Mesh Survivors Ireland, said: “The people who were injured are not sorted out yet. They need to rectify the first lot before they think about lifting the pause. 

She added: “Everybody to their own, and everybody should be given the option but given the option with fully informed consent.” 

A draft final report from the National Vaginal Mesh Implant Oversight Group is with the Department of Health.