From the late 1990s, around 15,000 women a year underwent surgery to insert mesh to treat pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Since 2013, however, the number of mesh procedures has significantly reduced due to the complications associated with mesh becoming more widely recognised.
Vaginal mesh is now believed to be responsible for a number of complaints due to potential erosion within the body, causing issues such as repeated infections, pelvic pain while walking, pain during sex and, in some cases, cutting through the vaginal wall. While it is estimated that between one and three per cent of women who undergo vaginal mesh implants suffer from complications, recent hospital figures have indicated that one in ten women suffer adverse effects.
Our team of clinical negligence solicitors has a wealth of experience in managing vaginal mesh cases having successfully settled a number of compensation claims in recent years. We have an in-depth knowledge of how these claims operate and the general issues that arise. Our team works closely with a network of highly competent experts who share our understanding of the devastating impact that vaginal mesh implants can have on patients.
We also appreciate that pursuing a vaginal mesh claim can be lengthy and difficult at what is an already stressful time so we pride ourselves on being easy to talk to, approachable and supportive.
Below are some frequently asked questions covering important points to note before consenting to vaginal mesh surgery; the steps to take if you are dissatisfied with the results; the process involved in bringing vaginal mesh claims; and the types of cases where compensation can be obtained.
‘Mesh’ is a term used to describe different types of manufactured biological or synthetic implantable devices. In gynaecology, it is one option for the treatment of pelvic organ prolapse (POP) and stress urinary incontinence (SUI). While the mesh has been an effective form of treatment for many patients, it has also caused devastating complications for others.
POP is when one or more of the organs in the pelvis fall out of their normal positions and bulge into the vagina. It can be the uterus (known as uterine descent), bowel (known as rectocele), or bladder (known as cystocele). A prolapse is not life-threatening but it can cause pain and discomfort.
SUI is the unintentional loss of urine. It happens when physical movement or activity such as coughing, sneezing, running or heavy lifting puts pressure (stress) on your bladder. SUI is a very common bladder problem for women.
You may notice any of the following symptoms:
Symptoms can appear as soon as one month after surgery.
Vaginal mesh extrusion is the most common vaginal mesh complication and occurs when the mesh comes through the skin and tissue of the vaginal wall and becomes exposed. This can cause vaginal bleeding, vaginal discharge and pain. It can also make intercourse for both participants painful.
Vaginal mesh erosion is another common complication that causes injury to surrounding tissue and organs including vaginal, bladder and blood vessel perforation. This is incredibly painful and often causes recurrent infections.
Unfortunately, as the mesh often affects other organs, it is much more difficult to treat than vaginal extrusion. Some women require multiple surgeries to remove parts of or all the mesh. On many occasions complete removal is not possible.
Studies have found that mesh is associated with chronic pain in the abdomen or groin. Removal of the mesh does not guarantee that the pain will resolve.
Mesh used for the treatment of stress incontinence is known to cause obstructive problems such as difficulties voiding and over-active bladder symptoms such as frequency, urgency and urge incontinence. Mesh can also adversely affect bowel function.
The most important thing is to seek medical attention as soon as possible so that any issues with the mesh can be identified and treated accordingly. This may result in the need for surgery to trim or remove the mesh. However, as mentioned above, removal is not always a viable option due to the risks involved.
Yes you can. Although the usual three-year limitation rule applies to vaginal mesh claims, this three-year period can, in some cases, only start to run once you become aware that the treatment you received may have been negligent.
You can still make a claim if the surgery was done on a private basis by pursuing a claim against the private surgeon directly. All private clinicians are obliged to have insurance so as soon as surgeons are notified of a potential claim against them they should inform their insurers. We will then liaise with the insurers on your behalf throughout the claim.
In order to give your informed consent for a medical procedure, you must have been informed of all of the ‘material risks’ of the procedure, including any risks the clinician thinks you may attach significance to, even if the chances of that risk materialising are low.
You must also be made aware of any reasonable alternative treatments that could have been available to you, for example non-surgical intervention like pelvic floor exercises or a ring pessary.
Therefore, even if you signed a consent form, you may still be able to bring a claim, providing you were not informed about all of the material risks or about the conservative management alternatives to vaginal mesh surgery.
In most cases vaginal mesh should never have been used in the first place. The three main reasons for not using mesh are because the patient has relatively minor prolapse symptoms or stress incontinence which are not bothersome; the patient’s symptoms have not been confirmed in tests; or conservative management alternatives have not been tried.
For example, the recommended first line treatment for POP and stress incontinence is conservative management to include pelvic floor exercises, physiotherapy and ring pessary.
There are also cases where the mesh was inserted wrongly due to a substandard surgical technique.
We find that many of our clients were not warned of the risks of vaginal mesh erosion or vaginal mesh extrusion before the procedure indicating that they had not given their informed consent.
The process starts with an informal discussion with one of our medical negligence solicitors with experience in vaginal mesh claims. If, following this discussion, the solicitor thinks there is a claim to investigate, funding will need to be put in place. You may have legal expenses cover as part of a household insurance or motor insurance policy which could fund your claim. If not, we can offer you a conditional fee agreement (CFA). This is more commonly referred to as a ‘no win, no fee agreement’.
Once funding is in place, your medical records will be requested. We will review your records and if we are of the view that your claim needs to be investigated, we will obtain expert evidence. Expert evidence is required because you must be able to show two things to pursue a medical negligence claim. Firstly, that the care you received fell below an acceptable standard (meaning it was negligent). Secondly, that this negligent care caused or materially contributed to an injury.
Both the type of expert and the number of experts used in each claim can vary but, generally speaking, we will obtain a report from a uro-gynaecological surgeon in the first instance to comment on whether the care you received was negligent and, if so, whether this negligence is the cause of your symptoms.
If the expert is supportive of a claim, a letter of claim will be sent to the defendant setting out all our allegations of negligence. The defendant will then have four months to provide a letter of response either admitting or denying our allegations. If a full admission is made and your claim can be valued, settlement discussions will begin at that point. However, if no admission is made, we may need to issue court proceedings.
Additional experts such as a colorectal surgeon, a pain management specialist and a psychiatrist or psychologist may also be used to assess your injuries.
There are two elements to a claim. First, ‘general’ damages can be claimed for pain, suffering and loss of amenity. This figure is based on previous court decisions and settlements and there are also judicial guidelines that provide estimated figures for specific injuries. The general damages awarded will largely depend on the extent of the injury and whether or not the symptoms are likely to improve over time or remain on a permanent basis.
The second element relates to ‘special’ damages for past and future losses which can be individually quantified. These include but are not limited to lost earnings, the cost of care and assistance from family and friends, additional travel costs, the cost of surgery/medical treatment on a private basis, the cost of aids and equipment, the cost of prescriptions and the cost of miscellaneous items such as sanitary products.
The value of a claim is very dependent on the extent of the injury and how that injury has financially affected the specific individual. However, most cases settle for six figures.
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