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Background and purpose

The Mesh Complications Management Training Pathway has been developed to equip doctors in commissioned regional specialised centres with the clinical skills needed to manage patients presenting with a wide range of mesh implant complications originally inserted for urinary incontinence (UI), pelvic organ prolapse (POP) and rectal prolapse.

It does not include management of patients with complications of mesh inserted for other reasons including abdominal wall hernia or for complications following non-mesh surgery for UI, POP or rectal prolapse.

This area of clinical practice is new and there are no formal training programs for surgeons worldwide, including the UK. Mesh implants were intended to provide permanent support to the pelvic organs to treat prolapse and incontinence. Surgery to remove them is often complex. There are significant public safety concerns regarding the safety of mesh removal surgery. The Pelvic Floor Oversight Group, the NHSE/I specialised commissioning process for Mesh Complications and the Independent Medicines and Medical Devices Safety (IMMDS) Review have been formed to support patients and provide safe care. The specialised commissioning process states that there is a requirement for training for Mesh Complications: ‘Individual Trusts providing Mesh Services must use the trust appraisal system to ensure surgeons are appropriately trained and current in their practice; adhere to clinical guidance; comply with national data requirements and report complications’.

The Independent Medicines and Medical Devices (IMMDS) safety review recognised the need for specialist mesh removal centres and recommended that consideration should be given to credentialing surgeons for complex mesh surgery (First Do No Harm; Specialist Mesh Centres: Section 5.102).

Pelvic Mesh removal surgery has been predominantly undertaken by urogynaecologists, colorectal and urological surgeons in an informal arrangement within a number of centres around the UK.

Surgeons have developed their surgical skills and expertise within their own departments to remove mesh implants from the vagina, bladder, urethra and abdominal cavity; often working with their colorectal, plastic surgery, orthopaedic and other colleagues.

Specialist Mesh centres across the UK are being commissioned by NHS England, NHS Scotland, Wales and HSC Northern Ireland in 2021. Within the commissioned centres, there is already a recognised requirement for surgeons with advanced training in urogynaecology (RCOG subspecialty accreditation), urology (special skills training in female, functional and reconstructive urology or colorectal surgery). However, specific and tailored training requirements in mesh implant removal does not form part of the commissioning specification.

The RCOG in collaboration with partners have developed a Mesh Complications Management Training Pathway. The collaboration included the Royal College of Surgeons (Royal College of Surgeons of England (RCSEng), Royal College of Surgeons of Edinburgh (RCSEd) and Royal College of Physicians and Surgeons of Glasgow (RCPSG), the British Society of Urogynaecologists (BSUG), the British Association of Urological Surgeons (BAUS) section of Female, Functional, Neurourology and Urodynamics (FFNU), the Associaition of Coloproctology of Great Britain and Northern Ireland (ACPGBI) and the Pelvic Floor Society (TPFS) as the specialist societies.

Purpose Statement (PDF)

Mesh Complications Management Training Pathway (PDF)