Statement on mid-urethral slings

RANZCOG

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists

RANZCOG supports the use of mid-urethral slings (MUS) in the surgical management of female stress urinary incontinence (SUI) by appropriately trained and credentialed surgeons, where women make well informed decision on this option.

RANZCOG has well evidenced and clear guidance for surgeons who undertake MUS surgery (RANZCOG Position Statement on MUS (2022). RANZCOG emphasises:

– Surgeons performing MUS (and other gynaecological procedures) should only operate within their capabilities and the scope within which they are credentialed.

– Patients must be given information to make choices on treatment, including benefits, risks and alternative treatment options including doing nothing. All women considering MUS should discuss and be provided with the patient guide Considering Surgical Mesh to Treat Stress Urinary Incontenance? (health.govt.nz) developed by the New Zealand Mesh Working Group

– Careful clinical consideration must be given to all MUS procedures and RANZCOG supports the use of multi-disciplinary teams to consider cases prior to a decision to proceed

RANZCOG understands the consumer concerns behind the recent call to suspend the implantation of vaginally-inserted mesh sling for stress urinary incontinence (SUI). RANZCOG acknowledges that some women have experienced significant harm from MUS surgery.

Female urinary incontinence is common and is often debilitating and can substantially reduce a woman’s quality of life. Non-surgical treatments such as pelvic floor exercises are helpful for some women however, for many women surgery is necessary to provide a more effective and enduring end to their symptoms.

Midurethral slings (MUS) were developed in the 1990’s to treat stress urinary incontinence, offering a significantly less invasive procedure. An extensive body of literature indicates that MUS surgery is a highly effective treatment for SUI, associated with less pain, shorter hospitalisation, faster return to usual activities, compared to historic options for treating SUI.

The limitation of the medical scientific literature and our local information systems is lack of long term follow up data. Issues related to surgical mesh have emerged as women have been empowered to speak up about their longer-term outcomes, clearly indicating the need for longer term monitoring of outcomes of surgical procedures.

Read RANZCOG’s full submission in response to the petition to suspend the implantation of mesh sling for stress urinary incontinence.

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