• `Thought I was going mad' with pain
Patients need to know the risk of surgical mesh before its use in procedures in which it has been associated with problems, urogynaecologist Prof Don Wilson says.
There was a place for surgical mesh in vaginal prolapse patients, but only when a higher risk of complications was acceptable, Prof Wilson told the Otago Daily Times.
Parliament's health select committee chairman Dr Paul Hutchison told the ODT the situation highlighted the need for rigorous testing of medical devices.
Prof Wilson has made a submission to the select committee, which is examining the problem in response to a petition presented by mesh sufferers.
He would like to see a national register of mesh implant usage, and appropriate training and certification of surgeons who use it.
''It's become apparent ... that the women who have the mesh put in the vagina, up to 10% - sometimes more - can have problems with the vagina not covering over.
"And sometimes they get quite a lot of pain and discomfort, and that's the main reason why some women have had some serious problems,'' Prof Wilson told the ODT.
Prof Wilson, who is based in both Dunedin and Nelson, said he used a very small amount of surgical mesh, which was safe and proven in certain procedures such as incontinence repair.
He has not used it for vaginal prolapse for a few years.
''Because [I was] only doing [surgical mesh prolapse surgery] very infrequently, I don't think it's appropriate for me to do it, so I now don't do it.''
Surgeons using the mesh should be performing a high volume of procedures.
There seemed to be fewer reports of harm from surgeons highly experienced in its use.
Part of the problem was a lack of information.
Women who had had recurrent vaginal prolapse might be more inclined to accept the higher risk associated with surgical mesh.
Recent publicity about the problem had created unnecessary fear in some patients about its use in incontinence surgery in which it was not associated with a high level of adverse reactions, Prof Wilson said.
The procedure used a thin strip of mesh for which there was good long-term evidence of its safety, Prof Wilson stressed.
The problem with surgical mesh in vaginal prolapse surgery was a lack of long-term evidence to support its use, he said.
Apart from using the women's own tissue, another option was biological mesh.
Derived from pigs, it dissolved into the body after several months.
There was also a lack of long-term evidence for it, but it did not appear to be causing the same problems, he said.
Prof Wilson expressed sympathy for the women who have been harmed by surgical mesh.
Health select committee chairman Dr Hutchison said when contacted it was important to remember surgical mesh use was developed to improve previously low success rates in prolapse and other procedures.
''From what we hear around the world, there has been significant concern about the use of surgical mesh, and there's no doubt in my mind that it should only be used when there is fully informed consent of the pros and cons, and when specialist urogynaecologists use it.''
The situation highlighted the lack of rigorous testing of medical devices in comparison with medicine.
Dr Hutchison, a National Party MP and a former gynaecologist who is retiring at the September election, said it would be for the next Parliament to decide its response to the problem.
He hoped the committee would issue its recommendations on the matter before Parliament went into recess before the election.
