Mesh slings made of the same polypropylene plastic as suspended women’s slings have been implanted into nearly 200 UK men suffering incontinence after prostate cancer.

The operations were part of a trial in 28 hospitals – where half the slings failed to fix the men’s urinary leaks.

Worse, just like the majority of women’s mesh implant trials, the full range of mesh-related pain was not logged in any paperwork.

The trial, called the MASTER study, shows that up to half the men given mesh surgery experienced:

• Burning or stinging when passing urine
• Discomfort and bruising in the perineum, scrotum and groins.

Other complications of men’s mesh slings include:

• Mesh slicing into their urethra
• Overactive bladder
• Groin pain
• Chest infection, pulmonary embolism, stroke, deep vein thrombosis
• Heart attack
• Death

The MASTER study wanted to see if men’s mesh slings were more effective than the traditional non-mesh surgery, which is an operation using an artificial urinary sphincter . This operation requires more time and surgeon skill than mesh slings.

The trial set out to see if mesh slings were quicker, easier and more cost effective.

Sound familiar?

Trial authors have recently admitted they need to compare pain levels between mesh and non-mesh surgeries for their five year follow up  – but why was this not included from the outset?

When Sling The Mesh first became aware of the MASTER study, in 2018, we checked the trial protocol and found men were not being warned of mesh risk, despite widespread mainstream media coverage and concerns about the plastic material.

However, we can see that in 2021, the British Association of Urological Surgeons created a leaflet which began highlighting risks by noting the women’s mesh suspension. The leaflet also says if removal of mesh in men becomes necessary, ‘it is a complex procedure which may not be technically possible.’

The leaflet further admits there ‘may be other longer-term risks with the use of mesh in men that have not yet come to light. However, the male urethra has a completely different anatomical composition to the female urethra.’

• Women’s mesh slings for incontinence were suspended in the UK in 2018 due to life-altering, irreversible complications. Their use remains on pause. The slings were also suspended in New Zealand in 2023.
• Previous research shows artificial sphincter average cure rate is 83% compared to male mesh slings 63%. So why risk mesh problems at this low cure rate?

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BACKGROUND READING

Information from trial documents. The male sling is made from non-absorbable plastic mesh and is surgically inserted under the urethra to support the bladder. In contrast to traditional artificial sphincter surgery, it does not need to be deactivated by a pump so the patient does not need to do anything to operate it.

• A sling is easier / takes less skill for the surgeon to insert than an artificial sphincter.
• A male sling costs £6,000. (NHS cost £4,000, device cost £2,000)
• An artificial urinary sphincter costs £9,000. (NHS cost £4,500 device cost £4,500)
• Trial Registry ISRCTN49212975. Registered July 2013.
• First patient randomised in January 2014.
• The study claims that the incremental cost-effectiveness ratio for male slings compared with an artificial urinary sphincter suggests a cost saving of £425,870 for each quality-adjusted life-year lost. The probability that slings would be cost-effective at a £30,000 willingness-to-pay threshold for a quality-adjusted life-year was 99%.