Dr. Suzanne O'Sullivan:

There are different types of mesh. It is not a one-size-fits-all product by a long shot. There are tapes for incontinence, which can go in two different places. There are different challenges associated with removal depending on the type of tape. The mesh that is used for vaginal prolapse is different. It has a larger surface area, which results in challenges for full removal. There may be a sequela of scar tissue formation and real issues with vaginal and sexual function after full mesh removal surgery. If mesh is in the wrong place, it must be removed. If it is in the bladder or has come through the vaginal skin, there is no doubt it must be removed. However, it is not always clear that symptoms are directly related to the mesh and that full removal will therefore sort them out.

The problem is we want to deal with the symptoms and make things better as safely as possible while causing as little harm as possible. Nobody is saying total mesh removal is not ultimately going to be the right thing but our approach and best practice everywhere is it should not necessarily be the first port of call. We should look at the issues and at the possible causes excluding mesh, because there can be other causes. We have had several patients referred to us with what were thought to be mesh complications which were actually totally unrelated. We have operated on patients for whom the mesh was not the problem at all and for whom previous procedures had caused the problems. It is a very large area. It is not simple and straightforward. These are complicated procedures and solutions. As I have said, we aim to treat women as holistically as possible and to look at every aspect of their care, including their physical care, their sexual care, their pelvic floor care and care of their mental health. We are working hard to develop these services and to make them as good as they can possibly be to keep women as safe as possible. That is first and foremost in our minds and it is a big concern because there is a narrative out there that total removal-----