91色情片

IN THE late 1980s, the medical industry was looking for new ways to treat women experiencing urinary incontinence and vaginal prolapse, both relatively . At the time, doctors suggested physiotherapy, weight loss and other non-surgical interventions, with complex surgery as a last resort.

When mesh implants came along, they seemed like a simple and convenient alternative: a flexible plastic scaffold that took less than an hour to implant and allowed women to leave hospital quickly and get on with their lives. Permanent mesh implants became standard treatment for millions of women with these conditions.

They have proved effective in many cases. But some women have experienced complications, including mesh eroding through the vaginal wall or piercing the bladder, nerve damage and infection. The implant can cause chronic pain, sometimes so severe women are barely able to walk.

Tens of thousands of women around the world have brought . The US Food and Drug Administration reclassified mesh as a 鈥渉igh-risk鈥� device in 2016. More recently, and have banned its use in some circumstances. And in July the UK鈥檚 suspended the use of mesh in England for stress incontinence.

The mesh was designed to allow bodily tissue to grow through it, so it is very hard to remove. Sohier Elneil at University College Hospital in London is one of fewer than 10 surgeons in the UK able to carry out the procedure. She performed her first mesh removal in 2005 and, since then, has been at the forefront of the campaign to raise awareness of mesh complications.

How bad is the situation?

It鈥檚 a crisis that鈥檚 probably unprecedented 鈥� we still don鈥檛 know the depth of it. Worldwide, were sold between 2005 and 2013, and we will have to monitor patients for the next 15 to 20 years.

The complication rate is around who receive mesh, according to research I was involved with. And that鈥檚 just for the first five years after implantation 鈥� we have really limited . But there are indications that complications could be as high as .

The complications can be serious, so why have doctors been using the material for so long?

Originally, the complication rates were deemed to be between 1 and 3 per cent. But this was based on hospital data, where there was no standardised way to record mesh complications and removals. And these figures didn鈥檛 consider patients who had gone to a family doctor or pain clinic.

Why did you start removing mesh?

Women with mesh implants would often come into the chronic pain clinic I ran with colleagues at University College Hospital in London. We initially focused on using medication and other pain management strategies but a significant group of patients did not respond. We concluded the only thing would be to try to remove this mesh.

Do women鈥檚 symptoms improve after the mesh is removed?

In certain patients, things do improve and generally women are back on track. But the pain doesn鈥檛 always go away. There are long-term consequences even after you have taken the mesh out, including an seen in some people, as well as complex nerve problems affecting the pelvis and lower limbs.

How many people in the UK are qualified to insert mesh?

Hundreds are qualified to insert it, but relatively few are qualified to remove it. My training involved a lot of complex vaginal surgery, in particular in women who鈥檇 had really bad, traumatic childbirth. So my skill set came from that background. Mesh removal is difficult and occasionally scary surgery. The mesh adheres to the bladder, urethra, vagina, blood vessels, nerves and bones. Once removed, the symptoms of incontinence and prolapse often return and so one needs to consider non-mesh options to restore functionality. That can be difficult in tissue that has been chronically inflamed or infected by the mesh.

鈥淭his crisis is unprecedented. We still don鈥檛 know the depth of it鈥�

Even though others can do removals, I understand women seek you out.

Many patients were dismissed for a long time, so they lost trust in their doctors. They want somebody who will listen to them. There鈥檚 also a group of women who feel that nobody else can do their surgery, and there鈥檚 an element of truth to that: many surgeons are starting to learn how to deal with potential surgical complications, but many are still not far enough down the road of experience.

You and others face resistance for speaking out against mesh. What do you think is behind that?

There has been a great deal of resistance, even anger, from some clinicians, even though evidence is coming out all the time. I think there are some who believe this is media hype and upset, and that women have jumped on the bandwagon. And of course if a surgeon is stopped from using mesh, and they haven鈥檛 been trained in all the other complex surgical techniques, they cannot offer a surgical option to their patients, so they have no alternative. Some doctors are taking it personally: they fail to recognise that the injury isn鈥檛 to them 鈥� the injury is to the women.

So, what鈥檚 the alternative?

Research shows that over with stress urinary incontinence who committed to physiotherapy did not need any further intervention. So, many clinicians are reverting to conservative measures first before considering surgery, and some are retraining in the traditional surgical techniques, which existed in the pre-mesh era.

How do you feel about the issue from a cultural perspective?

It鈥檚 no longer just a mesh issue or a pain issue. This is about right of access to good healthcare, and belief in women: it鈥檚 a women鈥檚 rights issue. What makes me angry is the fact that many women affected by complications were not listened to. They were ignored, patronised, and many were sent to psychiatrists or psychologists when their problem was physical. Sometimes these women couldn鈥檛 walk unaided, couldn鈥檛 function, gave up their jobs, couldn鈥檛 look after their families 鈥� the impact on their quality of life was huge.

What has happened in the past few years has made me sad because it has affected the way I think about my profession. But occasionally in life, and especially in medicine, you must stand up because you have to make people think differently.

Is the situation getting better in the UK?

Until the recent suspension led by Julia Cumberlege and her team in tandem with NHS England and the Department of 91色情片, people were still using continence and prolapse mesh. The suspension has meant many have stopped, albeit temporarily. But we are just at the tip of the iceberg in dealing with the complications of the mesh already implanted. This is going to get bigger in years to come, globally. I have several trainees and colleagues working with me, learning how to do removals. And . Many women are telling doctors: I鈥檓 not having this, thank you very much.

The suspension is a good result for the women: it is a vindication. I suspect using mesh will become more difficult from now on.

This article appeared in print under the headline 鈥淭he surgeon fixing a scandal鈥�