There are three main surgeries offered to treat SUI, two of which offer to support the urethra and one which involves the use of an artificial urethral sphincter. Artificial sphincters are rarely used. The two remaining types of surgeries are retropubic suspension, which involves supporting the urethra with sutures, and sling surgery, which involves supporting the urethra with a graft. Grafts are either biological or synthetic. Biological grafts can be autologous (fascia/connective tissue taken from your own body), Allograft (fascia/connective tissue taken from a cadaver) or Xenograft (animal derived collagen tissues typically from a cow or pig).
Synthetic meshes are typically made with polypropylene (also called prolene) which is a type of plastic that is used for packaging and carpet backing. When doctors talk about mesh slings, they can call them by many names – tape, rippon, elastic band etc. They can also refer to them as mid-urethral slings (MUS). These MUS’s fall into three categories – TVT, TVT-O and mini-slings (also known as single incision slings – SIS). Regardless of what they are called, they are made from knitted plastic and often have sharp edges.
A report into corruption in healthcare by BMJ in 2016 showed that corruption is rife in the global healthcare industry, finding that “people, companies, and groups involved in healthcare were placing their private self interests over wider public health goals”. Unfortunately, synthetic mesh to treat SUI, pelvic organ prolapse and hernia is manufactured and sold for profit. Enormous controversy exists surrounding mesh, the latest of which is a 60 minutes documentary which uncovered serious corruption at one of the largest mesh manufacturers, Boston Scientific. It’s not just a US problem, similar documentaries have aired from Sky News in UK, W5 in Canada and ABC News in Australia. Similar mesh is used for hernia operations which is also causing serious health issues according to this BBC documentary released in 2017.
Most studies into mesh are sponsored by the manufacturers which is an obvious conflict of interest. Manufacturers of the mesh devices contribute to teaching schools and in many cases make contributions to individual doctors. Many surgeons, particularly those who graduated since the late 90’s have little to no experience in the traditional SUI surgeries having been trained only with mesh products. Taking mesh away from these young doctors threatens their livelihood which explains why many are so outspoken in favor of mesh. If you are based in USA, you can check the payments your surgeon has received from mesh manufacturers on Dollars for Docs or Open Payments Data.
A typical mesh operation takes 20 minutes. Traditional surgeries to treat SUI takes about one hour. This means a surgeon will see less patients if using traditional treatments, which equals less money – again threatening the livelihood of the surgeon.
Many “not-for-profit” societies and groups receive large payouts and sponsorships from mesh manufacturers. In many cases these societies are responsible for guiding governments on the safety of the products and procedures. Patient support groups also receive donations to push the mesh agenda. The level of corruption is just mind-blowing! A new documentary, The Bleeding Edge, airing on Netflix in July (2018) will attempt to uncover some of this corruption. You can find out more about The Bleeding Edge on Facebook.
This study from 2015 explores the lifecycle of TVT-Secur (J&J Ethicon). TVT-Secur was one of the first mid-urethral single incision slings (SIS) to come on the market. The lifecycle of this device is a great example of a product being pushed out and adopted by the medical profession without testing, and subsequently causing a great deal of harm to many women unnecessarily.
All of the above makes it hard to trust those who should have the patients best interest at heart. We will attempt to weed through the available information presenting the case for mesh as it stands today.