Comment
Earlier this year, all mesh sling and mesh kits were banned from the UK
following the Cumberlage report. We should all support the Cumberlage
banning of mesh sheets, but not slings1,2 . I write as
the co-inventor of the midurethral sling1 (MUS)] to
present the historical and other scientific data which supports
retention of the MUS. Slings work very differently from mesh sheets.
They create new collagen to strengthen the ligaments which suspend the
organs, fig1. A tape placed along the anatomical pathway of the
pubourethral ligament “PUL”, fig1 cures stress urinary incontinence
(SUI) by restoring the urethral closure mechanisms1,2
,3. The same methodology holds for slings in other
ligaments4. A multicentre trial of 616
women4 demonstrated convincingly that mesh sheets are
not required to cure major prolapse. Liedl et al reported 90% cure of
vaginal prolapse (mostly 3rd or 4thdegree) at 12 months using slings ONLY to repair cardinal and
uterosacral ligaments. Vaginal herniations were re-attached, not
excised. There were complications, some major, and erosion rates of
0-3%. However, there was a singular absence of the massive urine loss
and nerve pain entrapments seen in the mesh sheet operations which
develop the “Tethered Vagina” syndrome by fibrosis of the
vagina5,6.
Mesh sheets restore neither structural anatomy nor function. They are an
ill-proven initiative which relies on blocking descent of the organs. A
simple transperineal ultrasound will prove that the prolapse is still
there, behind the mesh. The mesh sheets fibrose the vagina, removing the
elasticity required for normal bladder function3.
Unlike the MUS, mesh sheets placed behind vagina had little testing
prior to commercial release and can cause major de novo complications
such as massive urine loss from “tethered vagina
syndrome”5,6 or nerve entrapment due to mesh
shrinkage. Such complications are rarely, if ever, seen with
MUS.1,2,4,6
There are many worrying aspects of the Cumberlege report as regards the
MUS. Absent from the report is one critical detail: Cumberlage does not
differentiate between slings and mesh sheets applied behind vagina,
which are a very different technology from slings.
The science for ligament support of organs is well accepted. Ligaments
are fundamental to Delancey’s 1992 thesis of organ support, based on his
extensive anatomical studies7. The 1990 thesis of
Petros and Ulmsten , based on extensive animal and human studies1-4,6,8, emphasizes the role of collagen as the key
structural component of ligaments; also emphasized is that the
vagina requires elasticity for its role in bladder control