Removing urine strips: Patients feel abandoned by Quebec

Pains in the buttocks, hips and back prevented me from playing sports, I practically stopped any physical activity. I was very active before I got the tapeas you say. Medical intervention is required.

To date, women with these problems can go to the United States to undergo, at the expense of RAMQ, the intervention aimed at solving them. However, last March, Quebec’s opening of centers of expertise to treat women with complications was supposed to simplify the situation.

According to the Ministry of Health, these four centers should provide women with polyuric incontinence and pain management services, such as physical therapy, as well as access to examinations and many specialized doctors.

Patients must also be able to completely remove their suburethral cords as needed, which is a very delicate and invasive procedure.

Located at the University Hospital Center (CHU) at the University of Quebec-Laval; at the Sherbrooke Hospital Center (CIUSSS de l’Estrie CHUS); in the McGill Union; and at the University of Montreal Hospital (CHUM).

Picture of a tape under the bladder

Photo: Radio Canada

Pain that is difficult to treat

The decision to establish these centers was taken following the broadcast of two reports previouslyInvestigation, in 2019, as Kibbers testified to the difficulties they had in getting local professionals to recognize the pain associated with incontinence strips. They also lamented the inexperience of Quebec doctors in withdrawing them entirely.

They have formed a support group on Facebook that now has nearly 1,000 members.

Following its release, the Collège des Médecins du Québec (CMQ) published a report containing 17 recommendations. (A new window), including the establishment of centers of expertise for women who have problems with the strips and the appropriate training of doctors who should remove them completely.

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In particular, the CMQ recommended that RAMQ reimburse the medical costs incurred by Quebec women working in the United States until the centers are operational.

RAMQ asserts that it reimbursed 155 Quebec women, for a total of $3,487,500, between October 1, 2018 and February 28, 2021, when the centers’ opening led to the program’s termination.

However, patients and doctors are finding that not all of these centers are ready. Céline Danes went to her first meeting last month at CHU de Québec-Université Laval. I was so excited, and went there with a great deal of openness, but came away so disappointed, I have to say, as you say.

Celine Danes

She says the doctor who received her was very sympathetic, but explained to her that the Center of Expertise still lacked organization. Some doctors do not have the resources to operate these centers. As for physiotherapy, as she tells, I was advised to go to the private sector, because at the moment, in this center of expertise, there are no physiotherapists ready to treat women …

The President of the Urological Association of Quebec, Alain Millet, explains that one center of excellence […] Fully functional in CHUM And that his association works with all partners of the health network of […] Organizing these centers.

Arranging all this into experience centers takes time and a lot of people. That file was supposed to be in place in April 2021, but you know, with the pandemic, it’s not easy, he says: There are delays in the outpatient clinic, there are delays on the ward.

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However, Alain Maillette assures that women who need complete removal of the tape can be treated in Quebec. He adds that the surgeons – urologists and gynecologists – work as a team. We were asked to develop expertise, that’s what we do, along with gynecology, he adds.

We must be clear: a patient who needs an intervention aimed, for example, at a radical withdrawal can be treated in Quebec.

Quote from:Alain Millet, President of the Urological Society of Quebec
in work clothes.

President of the Urological Society of Quebec, Alain Millet

Photo: Radio Canada

The Urological Association specifies that surgeons also train by watching surgical videos, called “advanced classes.”

The Ministry of Health defends the expertise of specialized doctors working in the centers.

Our medical specialists in Quebec have the expertise to remove streaks. The reimbursement program was set up by RAMQ because we realized there was no regulation of care, but there was no question about the lack of experience in Quebec, explains the Department of Health and Social Services (MSSS) in an email to Radio Canada.

But the ministry’s reassuring tone contrasts with the concerns of some of the patients we interviewed.

Natalie Robinson visited the Sherbrooke Experience Center in July. The doctor explained to her that she would be able to perform the complete removal of the tape if necessary, but that the operation would be performed as a team. I feel like a guinea pig. I get the impression that they make a team because they don’t have the skill to work with us, as you say.

Celine Danes is also afraid of being a guinea pig. Doctors need good training […] I, no longer wait for experience centers, I will move to the United Statesas you say. But I really hope that RAMQ will be compensated by RAMQ, as the services I should have expected are still not offered.

Contacted by Radio Canada, the Collège des médecins du Québec says it is concerned with the situation described in this report.

He replied that a meeting was called in the coming weeks with the contributors to the college report in order to measure the extent to which the recommendations were implemented after a year had passed. In line with our mission to protect the public, we want to ensure access to care provided in the four Centers of Excellence and appropriate training for clinicians.

Suburethral strips are medical devices Implant in women to treat urinary incontinence, a problem that affects one in three women to varying degrees after the age of 40. According to the College of Physicians, about 10% of women will experience side effects as a result of these strips.

The problem is that it was not designed for removal, and so-called radical total removal surgery can cause irreversible damage.

A ban on the installation of problematic tapes, such as TOT or TVT-O, was introduced in 2019 in Quebec.

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