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

Uberoi, Pansy; Lee, Wai; Lucioni, Alvaro; Kobashi, Kathleen C.; Berry, Donna L.; Lee, Una

doi:10.1016/j.urology.2020.11.006

Cited by 10 publications

(19 citation statements)

References 21 publications

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Section: Strength and Limitationssupporting

confidence: 83%

“…While this consistency suggests our findings are reliable, we note that Uberoi et al interpretation of their findings had a stronger emphasis on the need for good patient–physician relationships [ 25 ], which was more implicit than explicit in the studies included in our systematic review.…”

Section: Discussionsupporting

confidence: 72%

“…After our cut-off date for inclusion, Uberoi et al [ 25 ] published their primary qualitative study of 19 women who had removal or revision of TVM for SUI. Uberoi and colleagues also emphasised the existence of numerous studies on surgical outcomes using standardised questionnaires and reporting broadly categorised quantitative data, as well as the limited number of qualitative studies on women’s experiences after TVM surgeries [ 25 ]. The findings of Uberoi et al [ 25 ] were consistent with our review, as follows: TVM surgery impacted multiple domains of women’s lives (sexual health, mental health, relationships and professional lives).…”

Section: Discussionmentioning

confidence: 99%

“…Uberoi and colleagues also emphasised the existence of numerous studies on surgical outcomes using standardised questionnaires and reporting broadly categorised quantitative data, as well as the limited number of qualitative studies on women’s experiences after TVM surgeries [ 25 ]. The findings of Uberoi et al [ 25 ] were consistent with our review, as follows: TVM surgery impacted multiple domains of women’s lives (sexual health, mental health, relationships and professional lives). Women’s concerns were not appropriately acknowledged, and this strained patient–physician relationships.…”

Section: Discussionmentioning

confidence: 99%

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Women’s Experiences of and Perspectives on Transvaginal Mesh Surgery for Stress Urine Incontinency and Pelvic Organ Prolapse: A Qualitative Systematic Review

Motamedi

Carter

Degeling

2021

Patient

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Background Trans Vaginal Mesh (TVM) surgeries have been used to treat stress urine incontinency (SUI) and/or pelvic organ prolapse (POP). Systematic reviews of clinical studies of outcomes suggest that the procedures have benefited a majority of women, while noting that a small minority of women have experienced harms. To provide a more complete picture of outcomes, we conducted a systematic review of the qualitative literature to provide a comprehensive analysis of women's own accounts of their experience. Method We conducted a systematic review and thematic synthesis of the evidence from the international qualitative literature on women's experiences of and perspectives on TVM surgery for SUI and/or POP between 1996 and 2020. We retrieved 6587 papers from PubMed, Cochrane, CINAHL, PsycINFO, Scopus, and Sociological Abstracts. After application of inclusion and exclusion criteria and full-text review of eligible articles, five articles were included in our systematic review. Results Findings from included articles were organised under three main themes: women's everyday lives were transformed by TVM surgery; women's expectations of and approach to their future lives; and women's critiques of TVM surgery. The transformation of women's everyday lives included a struggle to obtain recognition and support for their injuries before and after corrective surgery, ongoing limitations on their social, professional and personal lives, and compounding medical and psychological trauma as a result. Women's approaches to their future lives changed because of this transformation; we identified five main approaches, four were ways of accommodating change, a fifth involved being unable to accommodate life changes. Women's critiques included that TVM surgeries were overused, consent processes were poor, and surgeons' definitions of success were deficient. Women expressed concerns about the safety of TVM products and future risks of further complications and discussed multiple system failures in the health care they received. Conclusion This review suggests that discounting women's experiences has caused compound trauma and skewed the clinical evidence base; while harms occurred in a minority of women, we suggest they should be recognised as an ethically significant potential outcome. Approaches to TVM injury should attend to historical epistemic injustice and recognise women's agency.

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Section: Strength and Limitationssupporting

confidence: 83%

Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Women’s Experiences of and Perspectives on Transvaginal Mesh Surgery for Stress Urine Incontinency and Pelvic Organ Prolapse: A Qualitative Systematic Review

Motamedi

Carter

Degeling

2021

Patient

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“…Finally, regarding the expectations/beliefs component, there is a growing understanding that pain experiences are influenced by top-down factors such as expectations and beliefs. For example, research has indicated that when preoperative expectations for the surgical treatment of pelvic floor disorders were not met, women judged suboptimal outcomes as more serious adverse events [94], and this trend is reflected in the qualitative experiences of women with complications from pelvic mesh implants (see Table 1, see also [27,[29][30][31][32]). Furthermore, participants with a high level of pain catastrophisation have Known groups validity: POP-SS scores were significantly higher in women due to undergo mesh implant, versus women with conservative management or no management [56] Minimally important difference: Identified in samples of women undergoing prolapse surgery with and without mesh [57].…”

Section: Discussionmentioning

confidence: 99%

How is pain associated with pelvic mesh implants measured? Refinement of the construct and a scoping review of current assessment tools

et al. 2022

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Background Recommendations for the management of pain related to pelvic mesh implants are still under development. One limitation that has impeded progress in this area is that mesh-related pain has not been consistently defined or measured. Here, we reviewed the ways in which pain associated with pelvic mesh implants has been measured, and mapped the ways in which these existing measures capture the construct. Methods First, we reviewed existing accounts of the pain associated with pelvic mesh implants to develop a multifaceted construct definition, which includes aspects related to pain intensity, timing, body location, phenomenological qualities, impact/interference with daily living, and patient expectations and beliefs. Next, we reviewed the ways that the construct has been measured in the extant literature. Results Within 333 eligible studies, 28 different assessments of pain associated with pelvic mesh were identified, and 61% of studies reported using more than one measurement tool. Questionnaire measures included measures designed to assess urological and/or pelvic symptoms, generic measures and unvalidated measures. We did not identify any validated questionnaire measures designed to assess pain associated with pelvic mesh implants. The phenomenological, location, and expectation/belief components of the construct were not captured well by the identified questionnaire measures, and there is no evidence that any of the identified measures have appropriate psychometric properties for the assessment of pain related to pelvic mesh implants. Conclusions We recommend further qualitative research regarding women’s experiences of pelvic mesh-related pain assessment, and the development of a condition-specific patient reported outcome measure.

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When things go wrong: experiences of vaginal mesh complications

2023

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Introduction Previous research has suggested that complications stemming from vaginal mesh can lead to life-changing negative physical consequences including erosion and chronic pain. However, there has been little research on the experiences of women who have had complications. This study was aimed at exploring the individual experiences of women who have had vaginal mesh complications and how this has impacted them. Methods An explorative qualitative design was followed. Eighteen semi-structured interviews were conducted with women who had experienced complications with vaginal mesh due to stress urinary incontinence and pelvic organ prolapse. The mean age was 52 and the mean time since the mesh was fitted was 8 years (6 had since had it removed and a further 6 had had partial removal), and the mean time since first mesh-related symptom was 10 months. Data were analysed using thematic analysis. Results Four main themes were identified: perceived impact of mesh complications, attitudes of medical professionals, social support and positive growth. Results showed that participant experiences of their mesh complication were psychologically traumatic, including feelings of increased anxiety and fears relating to suicidal thoughts. Intimate relationships were also affected, with reduced sexual functioning and intimacy stemming from mesh complications. Negative experiences with medical professionals included feeling dismissed, a lack of recognition of their symptoms, and anger towards the profession. Conclusions The impacts of vaginal mesh complications were found to be wide-reaching and life-changing, affecting numerous aspects of participants’ lives. Greater awareness in this area is needed to provide further support for women experiencing vaginal mesh complications.

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

Cited by 10 publications

References 21 publications

Women’s Experiences of and Perspectives on Transvaginal Mesh Surgery for Stress Urine Incontinency and Pelvic Organ Prolapse: A Qualitative Systematic Review

Women’s Experiences of and Perspectives on Transvaginal Mesh Surgery for Stress Urine Incontinency and Pelvic Organ Prolapse: A Qualitative Systematic Review

How is pain associated with pelvic mesh implants measured? Refinement of the construct and a scoping review of current assessment tools

When things go wrong: experiences of vaginal mesh complications

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