Surgical mesh adverse reactions
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1 Surgical mesh adverse reactions A consumer voice on early identification in the GP setting Patricia Sullivan 28 July 2017
2 New Zealand support group
3 SMAR Surgical Alison with husband Jeff and children Latham, 13, and Jack, 10. Mesh Adverse Reaction
4 Who am I? For outstanding services to nursing and academic achievement G P
5 Risk classification Class II medium harm
6 Mesh Down Under 2016 Survey
7 Current data collection Existing concern yet slow progress
8 Product concerns
9 Surgical mesh treatment injury decided claims
10 Survey results Analysis of Surgical Mesh Survey (Pilot Study September 2016) Sample size of 60 of the 197 Mesh Injured New Zealanders who are members of the Mesh Down Under support group Response rate = Just over 30%
11
12 Post operative complications 1. Pain 2. Erosion 3. Hematoma
13 Post operative complications continued 4. Recurrence 5. Infection 6. Urinary tract infection
14 Post operative complications continued 7. Voiding dysfunction 8. Painful intercourse/intercourse impossible 9. Unexpected bleeding 10. Incontinence (urinary and fecal)
15 GP awareness 76.6% of respondents did not feel that their GP was aware of surgical mesh complications and symptoms
16 Mesh symptoms and complications Physical 1: Groin/leg pain (NEUROPRAXIA) 2: Back/abdominal pain 3: Recurrent UTI s 4: Vaginal sloughing 5: Dyspareunia 6: Voiding dysfunction 7: Incontinence (bw/bl) 8: Systemic pain/rashes 9: Auto-immune CFS 10: Fibromyalgia Neurological 1:Anxiety 2:Depression 3:PTSD 4:Adjust. Disorder 5:Suicidal thoughts Other 1: Can occur immediately or up to 15 years later 2: Chronic pain syndrome 3: Central Sensitisation 4: Huge family impact 5: Loss of general health
17 The role of the GP G P
18 Recall response
19 Where do we go from here? SMAR surgical mesh adverse reactions recognised
20 USA UK/Europe Australia NZ Maps
21 ACHIEVING BEST OUTCOMES Prompt diagnosis crucial 1: Generally, a very gentle but thorough PV exam will identify vaginal mesh erosion 2: Red flag for GP s highlighting mesh implants on hospital discharge notes 3: Adequate pain relief to prevent chronic pain syndrome 4: Pelvic Pain does exist G P
22 Thank you! Any questions? For full survey and detailed analysis see: You can contact me at Or
23 93% of Mesh Down Under 2016 Survey Participants Presented with Pain Complications. Regional Symptoms Non specific pain 2 Nerve pain (pudendal, obturator) and muscle spasm Dyspareunia (painful sex) Mesh erosion causing discharge, bleeding, Infection Urinary dysfunction (voiding, incontinence, UTI) Incontinence Bowel and Bladder 60 of the 197 mesh injured New Zealanders from the Mesh Down Under Website participated in the survey. Of these 50% were Age at time of mesh implant 45% were 5-9 years since mesh implantation, and 17% were years since mesh implantation 15 % Reported GP aware of surgical mesh complications 44 made a claim to ACC of which ⅔ were accepted Regional and Systemic pain symptoms develop as a result of: neuronal sensitization, cross-talk and pain centralization 3. It is no longer acceptable that pain be just managed. We must accept that pain can be treated. 1.Delavierre D, Rigaud J, Sibert L, Labat J. Definitions, classifications and terminology of chronic pelvic and perineal pain. Progres en urologie: journal de l'association francaise d'urologie et de la Societe francaise d'urologie. 2010;20(12): Rogo-Gupta L, Raz S. Pain complications of mesh surgery. Complications of Female Incontinence and Pelvic Reconstructive Surgery: Springer; p Feiner B, Maher C. Vaginal mesh contraction: definition, clinical presentation, and management. Obstetrics & Gynecology. 2010;115(2, Part 1): N = 60 Timing of pain onset in relation to tissue incorporation, mesh break-down and shrinkage should be considered. Symptoms of obstructive urination, defecation, or Dyspareunia suggest mesh misplacement. Often associated with retraction of the vaginal epithelium 2. Allergic/immunologic 2 Fibromyalgia hypersensitivity, inflammation, Rash, fever Mental Injury Chronic Mesh Pain The most common surgical mesh adverse reaction 1. Presentation and clinical implications vary greatly. Some suffer pain immediately after the mesh implant. Others start to have trouble much later, it may be a decade or so. Systemic Symptoms Diabetes Lupus Chronic Fatigue Scleroderma Thyroid problems Allergic or immune reactions to mesh may present immediately or in a delayed postoperative period.
Surgical mesh adverse reactions
Surgical mesh adverse reactions A consumer voice on early identification in the GP setting Patricia Sullivan 28 July 2018 New Zealand support group SMAR Surgical Alison with husband Jeff and children
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International Federation of Gynecology and Obstetrics COMMITTEE FOR UROGYNAECOLOGY AND PELVIC FLOOR MEMBER: TSUNG-HSIEN (CHARLES) SU, CHAIR (TAIWAN) DAVID RICHMOND, CO-CHAIR (UK) CHITTARANJAN PURANDARE,
JMSCR Volume 03 Issue 03 Page March 2015
www.jmscr.igmpublication.org Impact Factor 3.79 ISSN (e)-2347-176x Quality of Life among Patients after Vaginal Hysterectomy and Pelvic Floor Repair Operation ABSTRACT Authors S Lovereen 1, F A Suchi 2,