'Pause' has forced women abroad for surgery to treat incontinence for last seven years

Cork University Maternity Hospital (pictured) and the National Maternity Hospital offer mesh complication services. File photo

A dispute over how best to treat women suffering with incontinence has led to dozens of women travelling to Spain for surgery performed by an Irish doctor, it has emerged.

Incontinence is estimated to affect between one in two and one in three women during their lifetime. Some types of mesh surgery were paused here in 2018 due to serious safety concerns raised by women.

Other EU countries continue to offer mid-urethral sling surgery, but plans for reform of services in Ireland have stalled, leading to a lack of treatment options here. 

Professor Barry O’Reilly, obstetrician and gynaecologist at Cork University Maternity Hospital, and sub-specialist in urogynaecology, said: “This has been on pause for seven-and-a-half years in Ireland. We thought it would be temporary."

He described mid-urethral sling surgery as “the gold standard” internationally, and he raised concerns that all types of surgery have been bundled together and remain "paused".

Last summer, professor O'Reilly heard from a Dutch doctor about 60 Irish women who had been to Amsterdam for the mid-urethral sling surgery, which involves a small mesh strip used in surgery to treat stress urinary incontinence.

Professor O’Reilly explained why he has personally been travelling to Spain to carry out the procedures, saying: “I didn’t like the fact that my patients could potentially go out to see an unknown surgeon, do a procedure where we didn’t know what was being done and they would be coming back to be seen by me."

He has been certified with the Spanish medical council, and now does this surgery at the Vithas Alicante Hospital. His patients have been funded through the Cross Border Healthcare Directive, an EU scheme that refunds treatment costs for patients with a referral. 

“I’ve been there twice now,” he said. “It’s very satisfying to see patients smile because although they’re in a foreign country, they know who I am, and most importantly, they know when they come home, I’m there to look after them.” 

He added: “I did five the first time in November, and a few weeks ago I did eight patients. It’s gradually increasing.”  He will go again this month and in April, with each patient going through “a rigorous consent process” in Ireland first.

“I don’t get paid by the HSE to do this. This is a personal arrangement I have with the hospital in Spain to operate out there,” he said.

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The hospital is one of many EU hospitals offering care through the scheme. It partners with Irish firm Healthcare Abroad. This company’s former secretary, Chris Goodey, resigned in 2023.

CUMH and the National Maternity Hospital offer mesh complication services. Between 2018 and mid-2024, Cork treated 127 women and Dublin 189.

Waterford woman Terri Martin, a spokeswoman for Mesh Survivors Ireland — a campaign group for those who suffered severe complications following mesh implants — said she has ongoing concerns about any surgeries involving mesh, either here in Ireland or abroad.

She asked:
If you can’t do a surgery in this country for safety reasons, why would you refer somebody abroad to have that same surgery?

“With the cross-border [scheme] you have to be reimbursed, you have to have a referral for that. Why are they signing off on this?” She called for better access to other treatments that do not involve mesh surgeries.

A department of health spokesman said on Tuesday evening that it received an updated report in February 2025.

"The Department is currently liaising with the HSE and other stakeholders as part of an evidence-based process to determine whether it is appropriate to re-introduce the use of uro-gynaecological [transvaginal] mesh," he said.

He added: "This is a complex and sensitive issue which requires a safety-first approach; therefore it is not possible to give a timeline for decision at present."

 

• Niamh Griffin, Health Correspondent