Vaginal Mesh Survivorship

Pain and other complications of pelvic mesh: a systematic review of qualitative studies and thematic synthesis of women's accounts

OBJECTIVES

Synthesis of the experience of women with pain from pelvic or vaginal mesh or its removal, to identify pain-related problems and to formulate psychological aspects of pain.

DESIGN

Systematic review and thematic analysis of qualitative studies of pain from pelvic or vaginal mesh, or mesh removal, in women over 18 years, using individual interviews, focus groups, free text, or written or oral contributions to formal enquiries.

DATA SOURCES

Medline, Embase and PsycINFO, from inception to 26 April 2023.

ELIGIBILITY CRITERIA

Qualitative studies of pain and other symptoms from pelvic or vaginal mesh or its removal; adults; no language restriction.

DATA EXTRACTION AND SYNTHESIS

Line-by-line coding of participant quotations and study author statements by one author to provide codes that were applied to half the studies by another author and differences resolved by discussion. Codes were grouped into subthemes and themes by both authors, then scrutinised and discussed by a focus group of mesh-injured women for omissions, emphasis and coherence. Studies were appraised using an amalgamation of the CASP and COREQ tools.

RESULTS

2292 search results produced 9 eligible studies, with 7-752 participants, a total of around 2000. Four recruited patients, four totally or partially from mesh advocacy groups, and two were national enquiries (UK and Australia). Four major themes were as follows: broken body, broken mind; distrust of doctors and the medical industry; broken life and keeping going-a changed future. Psychological content mainly concerned the loss of trust in medical care, leaving women unsupported in facing an uncertain future. Mesh-injured women strongly endorsed the findings.

CONCLUSIONS

Pain and other problems associated with pelvic mesh are profound and far-reaching for women affected. Worse, they feel subject to continued gaslighting, including denial of their mesh-related problems and dismissal of their concerns about continued mesh insertion.

PROSPERO REGISTRATION NUMBER

CRD42022330527.

Listening to Women: A Qualitative Analysis of Experiences after Complications from Mesh Mid-urethral Sling Surgery

OBJECTIVE

To gain a detailed understanding of women's experiences after undergoing revision surgery for mesh mid-urethral sling (MUS) complications, qualitatively organize those experiences, and present insights as potential springboards for future research.

METHODS

We conducted a series of semistructured focus groups and interviews of patients who had undergone mesh MUS revision surgery at a single tertiary referral institution. Discussions were recorded, transcribed, de-identified, and analyzed using deductive and inductive content analysis. Two researchers independently performed line-by-line coding and 2 additional researchers reviewed the codes and transcripts as an audit.

RESULTS

Nineteen women participated in the study. Complications from mesh MUS surgery impacted participants psychologically, socially, sexually, and physically. Participants recounted that risks and alternatives to MUS surgery were understated during the informed consent process whereas benefits were overstated. Participants shared insights into negative and positive ways surgeons responded to postoperative complications and how their experiences impacted the patient-surgeon relationship.

CONCLUSION

The impact of complications from mesh MUS surgery is broad and can involve multiple domains of a woman's life. Improved pre-operative patient preparedness, empathetic response toward patients who present with complications, prompt referral to surgeons with experience in mesh MUS complications and multidisciplinary care will likely improve the patient experience and can serve as foci for future studies.