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Saskatchewan urged to cover surgical mesh removal

One woman has not been able to sit down for seven months, another says she feels like she has steel wool inside her and a third fears she might not be able to have more children.

Ruth Olson, Marika English and Stephanie Brad all say they're in agony because of complications from a surgical mesh and they're begging Saskatchewan to pay for its complete removal.

"We are angry, we are sick and we are in pain," Ms. English said at the Saskatchewan legislature.

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The women had surgical mesh inserted through their vaginas to help with urinary incontinence and pelvic organ prolapse – a condition where tissue holding pelvic organs in place becomes weak or stretched and the organs bulge into the vagina. But the women said their meshes have failed and are poking into other organs.

Ms. Brad said the mesh, placed inside her in 2006, eroded into her bladder. Part of the mesh was removed and since then she has undergone surgery twice to repair her urethra.

Ms. Olson said the mesh started pressing on her pelvic nerves after it was inserted a year ago. She spoke to reporters while kneeling beside the other women. "For the past seven months, I have been unable to sit without triggering unbearable pain."

The women said complete mesh removal is not available in Canada – that only partial removal is offered by a doctor in British Columbia.

"It's like a fishing net. Once it adheres in the body, it quickly attaches itself to tissues, blood vessels and nerves go through it," said Ms. English. "Doctors have to be trained in how to take it out because if they're not, they can cause more damage getting it out."

They said their specialists have referred them to a doctor at the University of California in Los Angeles who is trained to completely remove the mesh. But they said the Saskatchewan Ministry of Health has turned down their requests for funding out-of-country medical coverage.

The cost of going to the United States is about $30,000. The women have appealed the decision to a government committee.

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"In California, they have [done] over 400 mesh removals in the last five years," said Ms. Brad. "They use a tool called a translabial ultrasound to actually locate where all of the mesh is, then they remove it. In Canada, we do not use a translabial ultrasound for locating mesh. They blindly will pick away, just like picking away at bubble gum in hair, and hope that they got it all."

Saskatchewan Health Minister Dustin Duncan said the ministry has canvassed doctors across the country about mesh removal and the B.C. doctor said it can be done. "What has come back to us is that what is being requested in the United States is available in Canada," said Mr. Duncan.

"I think in fairness to the surgeon in British Columbia, he has not met any of these patients and hasn't had a proper consult with any of these patients. And so the information that has come back from the surgeon in British Columbia to the ministry and, I believe to the specialists here in Saskatchewan, is that determination of whether or not to do a full or partial would have to be done in consultation with the patients."

The U.S. Food and Drug Administration issued a public health notification about serious complications associated with the transvaginal mesh in October, 2008. In July, 2011, the FDA said it was concerned that the number of reports of complications remains high. The agency said in an update that "serious complications associated with surgical mesh for transvaginal repair … are not rare."

According to the FDA's website, from 2008 to 2010 the most frequent complications included mesh erosion through the vagina, pain, infection, bleeding, pain during sexual intercourse, organ perforation and urinary problems. "Mesh erosion can require multiple surgeries to repair and can be debilitating for some women. In some cases, even multiple surgeries will not resolve the complication," it said.

Lawsuits have been filed on both sides of the border over use of the mesh.

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Lawyer Paul Miller at Will Davidson LLP said Wednesday that his firm represents more than 160 women who have had the mesh. He said he's surprised by the number of women who come forward each week.

"The nature of the problem is so personal, it becomes so embarrassing that my guess is these are still way under-reported," Mr. Miller said in a phone interview from Toronto.

Ms. Olson and her husband borrowed the $30,000 for her to have the mesh removal surgery in California. It was done six weeks ago. She said the doctor is hopeful that she will be able to sit down again one day.

"We will never be back to our original condition. We have been permanently damaged," she said. "However, I am confident that the surgeon in California has given me the best possible chance of recovery."

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