How mesh became a four letter word

A simple pyramid shaped graph derived from Hospital Episode Statistics for England over the past two decades tells the story—or at least part of the story—of how mesh became a four letter word.

When it was introduced in 1998 as a novel surgical treatment for stress urinary incontinence, the polypropylene mesh sling was hailed as a quick and easy remedy for women and eagerly adopted by surgeons. Twenty years later, amid claims that it has left many thousands of women around the world irreversibly harmed, mesh is at the centre of a storm of protest that has launched tens of thousands of compensation claims, divided the medical profession, exposed major flaws in regulatory procedures, and raised serious questions about the financial relations between clinicians and researchers and the manufacturers of devices that outraged campaigners say are not fit for purpose.

The story is hair raising, offering lessons for the entire medical community, manufacturers, and regulators.

In 1998-99 just 214 women in England had treatment for stress urinary incontinence, a common condition typically triggered by childbirth or the menopause, with an innovative and minimally invasive technique known as the tension-free vaginal tape (TVT) procedure. But the following year there was an explosion in the use of the procedure and a closely related variant using transobturator tape (TOT).1

By 2001 the TVT procedure had already become “the most performed operation for stress incontinence in the UK,”2 and by 2009 the annual number of operations using polypropylene mesh tape had climbed to an all time high of 11 365 in England.3 Over the same period, use of the previous standard treatment for the condition, colposuspension, …