Vaginal mesh – advice for patients

//Vaginal mesh – advice for patients

It has been reported in the news that there will be a national ‘pause’ in the use by the NHS of surgical mesh/tape to treat stress urinary incontinence (SUI) and for urogynaecological prolapse where the mesh is inserted through the vaginal wall, and that this pause will take the form of a high vigilance restriction.

This decision followed a recommendation from Baroness Cumberlege, chair of the Independent Medicines and Medical Devices Safety Review. Baroness Cumberlege’s recommendation came after meetings held with women and families adversely affected by surgical mesh procedures.

Surgery for stress urinary incontinence with tape has provided successful relief of symptoms in many cases – however, some patients have experienced severe and debilitating complications following mesh and tape surgery. There has already been guidance to the NHS that vaginally inserted mesh for the treatment of vaginal prolapse should no longer be the primary surgical option.

A mesh working group was set up at NHS England and identified a series of actions to optimise care for women undergoing treatment for stress urinary incontinence and pelvic organ prolapse in their report in 2015, which have since been implemented by the Mesh Oversight Group.  More information about this can be found at the link below.

https://www.england.nhs.uk/mesh/ 

NHS England have also released some frequently asked questions, below.

Q: I recently had mesh inserted to treat SUI and I am experiencing complications – what should I do? 

A: If you have any symptoms that are worrying you, seek advice from your doctor. Your GP will be aware of an information pack, available at http://elearning.rcgp.org.uk/mod/page/view.php?id=8254.

Q: I recently had mesh inserted to treat SUI but am not experiencing complications – should I get it removed? 

A: Many patients have had successful mesh and tape surgery without complications. If you are not experiencing complications, there is no need to take any action.

Q: I am on a waiting list to have surgery – am I still able to have this? What support will be offered? 

A: It is likely that for the majority of women, a delay until the pause ceases will be the most appropriate option.  A Clinical Advisory Group has been convened by NHS England, which will advise on how patients should be supported during the pause. In certain selected patients for whom a delay or alternative treatment would not be appropriate, some such surgery may proceed during the pause under conditions of high vigilance. If you are already on the waiting list or have been given a date for your surgery, your hospital will discuss with you a plan for your ongoing care.

Q: What alternatives are available to women who were due to have a tape procedure to treat SUI? 

A: Treatment options vary between individual patients depending on the nature of their condition, and should be guided by medical consultation. It should be noted that non-tape surgical procedures for stress urinary incontinence are often more invasive and technically complex, and carry their own risk of complications. It is likely that for the majority of women, a delay until the pause ceases will be the most appropriate option.

Q: What alternatives are available to women who were due to have vaginally inserted mesh to treat Pelvic Organ Prolapse? 

A: Treatment options vary between individual patients, and should be guided by medical consultation.

Q: How will services cope with a greater demand if the use of mesh is paused? 

A: NHS England is establishing plans to quickly and safely implement this period of high vigilance, while providing appropriate support to patients whose treatment will be affected.

Q: For some patients a mesh procedure is the only option – what will they do? 

A: In certain selected patients for whom a delay or alternative treatment would not be appropriate, some such surgery may proceed during the pause under conditions of high vigilance. Assurance will be required from hospitals to ensure appropriate patient selection, informed choice, and strict adherence to NICE’s Interventional Procedure Guidelines have taken place.

Q: Will I still be able to have a mesh procedure if I understand and accept the risks? 

A: It is likely that for the majority of women, surgery will be delayed until the pause ceases when all recommendations have been put into place. In certain selected patients for whom a delay or alternative treatment would not be appropriate, some such surgery may proceed during the pause under conditions of high vigilance. Assurance will be required from hospitals to ensure appropriate patient selection, informed choice, and strict adherence to NICE’s Interventional Procedure Guidelines.

2018-07-13T15:42:49+00:00 July 13th, 2018|News|