Dozens of women travelling to Spain to get treatment for incontinence

The Claire Burn Show on News Talk with Aviva Insurance A dispute over how best to treat women suffering with incontinence has led to dozens of women traveling to Spain for surgery performed by an Irish surgeon. Incontinence is an issue that affects up to one and every two women during their lifetime and obstetrician and gynecologist at Cork University Maternity Hospital with a sub-specialist in Eurogon Ecology. Barry O'Reilly is with me now and Barry, you are the surgeon who treats these patients in Spain. It's a sort of a bizarre setup. You might explain to us how it came to this point. Yeah, good morning, Claire. Good morning. Yeah, it is, I suppose, a little bit bizarre, but I suppose it was my solution in dealing with a problem that we've had here in honor of the last seven and a half years where there's a pause on this pause I said in vertical, it's not a ban on this really ghost-founded effective treatment for women suffering with their urine incontinence and particular stress incontinence, which is leakage with coughing and sneezing, laughing, jumping. So it has a profound impact on quality of life and we simply haven't had the option to surgically manage this group of patients, which I guess one and two and a three women suffer from this and suffer in silence. So we're currently the only country in the world pretty much with this pause on performing this type of surgery. And just explain to our listeners, if you will, how that pause came about and what was the controversy that led to it? Yeah, so I think it's important to understand the word mesh has been used and in terms of gynecological procedures, there were two raw but very different types of surgeries that used mesh as a support system. So one was for the gynecological prolapse surgery. So I'm going to have lots of pretty severe vagina prolapse, you could use mesh as an overlay supporting material. But the other significant surgical procedure was the sling procedure, which was a smaller little band of mesh that sits underneath the re-thread to support it, acting like a hammock. And while there were complications, I bear with these particular type of procedures, been around for about 25 years. But in 2018, the FDA in the States recognized that there were an increase in number of complications associated with mesh. And I think we all concur internationally that it was probably because it was such a lucrative market for industry, if one in two, one in three, one in suffer from the leakage, that there were lots of different products on the market. And probably the surgeons that weren't particularly trained in the procedures were doing this in the States. And there was a big class actions result, again in Australia. And this was a photo-graph in the world where applause was put on the use of these products in the UK and Ireland followed suit in 2018. And we were instructed at the time as a group of specialists in this country to address four main categories to overcome the pause. And they were basically improved consent process. And that was very necessary to establish a registry of the implants, thirdly to improve credentialing or doctor training and fourthly to audit our results. So we addressed that quite rapidly, but I think the problem that occurred after this was that there were changes of government. The COVID crisis hit for about two or three years. And other different issues arose in health service. So this was kind of put on the long finger. So all of this means that these operations haven't been happening in Ireland for seven years? Exactly. At all. And we haven't done that. Well, not for women. Now the interesting thing is that there was no pause put on this particular product used in men. I'll be it, obviously, a significantly smaller number of men suffer from incontinence usually as a result of prostate surgery. And can you explain why that is the case? It's okay for men, but not for women to have this product used. No, I can't explain it. All right. So all of this leads us then to what you're doing, which is taking patients or operating on patients, Irish patients in Spain. Well, I think here's the frustration seven and a half years as I've said, you know, my primary practice in the hospital is dealing with women who suffer from pelvic floor dysfunction usually as a result of childbirth. And I suppose the frustrations of not being able to help these women led me to look at what else, what other options were available. Each year we felt that the pause might be lifted, but again, 2025 came and went. But in June of last year, I was talking to a colleague of mine and the Netherlands who mentioned that he treated 60 women from Dublin who were referred there through a treatment abroad scheme to have their surgery with him. And he asked, obviously, if I could refer patients from Cork, but what bothered me was the fact that patients were going out to see a stranger for the first time for consultation and returning six weeks later for their surgery with no follow-up. So I tried to think, well, is there a way that I can look after my own patients and I became aware of the EU cross borders directive, which allows citizens from any European country to take a surgery. And people have used that happen day for joint replacement for cataract treatment and so on. But now they're also using it for this. Well, it was, I suppose, a bit controversial, but yeah, I was clearly aware that this was a fantastic European directive. And that many patients had developed, as you said, different types of surgeries in Spain or other European countries. And I thought, well, what if we could do this procedure, which is, you know, as I said, the pause is only in Ireland. So these procedures are done in Spain. And rather than my patients going to a stranger, it wouldn't be more reassuring for them to know that I was there for them during the surgery and most importantly be there for them afterwards to follow up. So what do you do? You take time off from your work here? Yeah. So, well, the first process I went out to look at the hospital to make sure I was happy with the situation there and it was a fantastic facility with great staff. And so that gave me confidence to bring my patients there. So what I do, and I suppose I've kind of dioried myself to go every six weeks or so for a weekend. So I go over in the Friday evening, my patients when I'm there on Friday evening, make sure they have any last minute concerns addressed. And then I operate in the man Saturday and I see them on Sunday morning and I find home. So it's a weekend that I'm not working in the HSC. This is wild. This is, this is sort of crazy. I feel like I'm in an alternative universe here. You know, these are your Irish patients and you're all flying to another jurisdiction to do an operation which could very easily be done at home. I mean, it's great that it's happening. It's great these women are getting their treatment and that there's follow-up care. But you do realize that it does sound, I think you do realize that it sounds crazy. Well, I will definitely do realize that the reminds us of that on a weekly basis. But, you know, it's a real time solution I suppose to address. What, what reinforced my feelings about giving the right thing here is that seeing these I forgot what a great operation it was having not done for seven and a half years. Obviously, I went through retraining before I went back to stay. But the satisfaction and the happiness of your patients when you walk in the door at six weeks after surgery is really quite profound. And, you know, the job satisfaction that is huge and obviously medicine. We don't get many happy moments when we can have our patients. So, so completely so that reinforced my reasons for doing it. I've known that it was lifted but as I said, you know, we've told us five years ago. Has anything been said about when it will be lifted? Look, you know, I think there's a number of people working really hard in the HSC and Department of Health. But I think that as I said that the problems that are come true and the health services that are faced over the last number of years, the COVID or other issues that are facing this initiative. Perhaps the, the, I was taking off the ball here, you know, I think I wish you were in a very stoic. They tend to put up with this issue. It's not life and life and death is not a cancer issue, but it's a profound quality of life problem. Yes. And women have just suffered with this and put up with this and I've encouraged women to come forward and, you know, help is there and their life can be changed. And tell me if you're flying home on the Sunday having done the operations, when do the women fly home? Do they have to stay for a number of days or can they leave straight away? No, there's, I suppose there's different options. A number of them will come home on the Monday. Some might stay next couple of days. They often bring a parking with them. So other countries really quite a nice place to recover. You know, it's a bit of a break. So they can fly home on Monday at the earliest and put some stay until Tuesday Wednesday, you know, it depends on right. who, unfortunately, have removed their flight in court to Alicante on a Friday from April. So if anyone from Reiner is listening, we'd love a few restored that place. And are women traveling to other places? Then you mentioned the Netherlands. So women are clearly traveling to other places to have this done. Yeah, I mean, this has been happening on a very small scale over the last number of years. I suppose women have taken the initiative themselves to self-pay and go to centers in Europe. I'm not aware of anyone else, although my colleague in the Netherlands, but I think there are other places that offer it. But I suppose my problem is that I prefer if my patients are treated by me. So these women who you're treating, are they paying in advance for this and then claiming this back from the cross-border treatment directive? Yeah, so I'm not totally offay with the process. The cross-border directive is fully, the HC fully supported together. And I've been working on this for a while. They use various logistic providers. Healthcare broad is the one that is probably the largest one in this country. And my understanding is that they organize the finance for patients. We pay the private hospital in Spain, via Smedi Mar. This is the one that I use. And that package fee is reimbursed to the patients and subsequently by the HC. Now we have some questions coming in around exercise, pelvic floor exercise and whether that works. People who feel that they might be heading down this road and wondering whether a regime of pelvic floor exercises will help. Or do you get to a certain point, Barry, where that's not going to help? Yeah, absolutely. This affects women of all ages and the first interaction or instruction or advice that we would give is the importance of pelvic floor rehabilitation. I mean, that's the fundamental better off of the pelvic organs. So it's very important that's strengthened. So all our patients and it's caring in the consent guidelines that we've established here in Ireland. For when this is re-issues that physiotherapy has to be tried and failed before surgery is considered. Okay, lots of people getting in touch. Another example of women being treated as second-class citizens and it's shocking. Women shipped away from medical care. Some things never change. And so it goes on. I think people were very much not aware that this is happening. But clearly this is a huge issue. I think it's worth pointing out that in fairness is a small group of women in this country, but obviously throughout the world at the time, who unfortunately did experience some complications. I understand you'd be obsessed with it. And they've had quite a significant I guess presence with well, it might be a small group of people, but it's a huge issue for you if you're going through this and you can't get the medical care that you absolutely need in your own country when it's available in every other country. Exactly. Yeah, I mean, this is a small group of women I suppose have demanded that the pause isn't lifted and my answer to them is, you know, we have one of the two complications centers in the court from them and stuff, my two colleagues. But so the systems are in place and have been supported by the HSE, but you know, for them to remove the freedom of choice for the rest of the women in the armed, I think is terribly unfair. Okay, and that is the controversy around the mesh product that you have addressed there. And that is something that we might talk about in more detail again. But for now, Barry O'Reilly, thank you for joining us. Barry is a clinical professor in obstetrics and a gynecologist at Cork University, maternity hospital. The Claire Burn Show on News Talk with Aviva Insurance.