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RCOG and BSUG response to NHS Mesh report

News 25 July 2017

NHS England has today published a new report setting out progress to improve information about treatment options and support for women with stress urinary incontinence and pelvic organ prolapse.

The report outlines the ongoing work taking place across the NHS to reduce the number of women experiences complications as a result of vaginal mesh surgery and puts in place the necessary care and support for women who do.

An interim report in 2015 recognised three key areas of action and made recommendations on what should be done to tackle them. These focussed on improving clinical quality and practice to achieve good outcomes consistently, better data and information and informed consent. Today’s report describes how those recommendation are being delivered.

Clinical representatives from the Royal College of Obstetricians and Gynaecologists (RCOG) and British Society of Urogynaecology (BSUG) sat on the oversight group which produced the report, and a lay representative from the RCOG’s Women’s Voices Involvement Panel sat on the working group that developed the new patient information leaflets.

Commenting on today’s report, Mr Eddie Morris, vice president for clinical quality at RCOG, said:

“It is absolutely right that women who experience complications relating to mesh devices can now be referred to specialist units that have a multi-disciplinary team of professionals who can listen, advise and support them. Women with urinary incontinence or pelvic organ prolapse must be made aware of all the treatment options available and empowered with the information they need in order to make informed choices. For many women suffering from these conditions, mesh devices can be an effective form of treatment which is less invasive than alternative surgical procedures.”

Professor Jonathan Duckett, vice chair of the British Society of Urogynaecology (BSUG) and member of the MESH oversight group, said:

“We are aware that women may experience complications following mesh surgery many years after the procedure, therefore primary care is likely to be the first place they raise their concerns. We are pleased that a learning resource for GPs has been created so that women with mesh complications receive the appropriate support and are swiftly referred to specialist centres.

“We are also pleased that women will now have access to consistent information to enable and support them have a structured discussion with their clinician about all the treatment options and ensure the risks are fully explored and understood. The leaflets will also ensure that clinicians can be responsive to the worries of their patients and can address concerns with guidance in a consistent, high quality and person centred manner. 

“We will continue to promote the BSUG database to clinicians as a way of collecting more data that tells us about complications and we encourage clinicians and patients to report adverse incidents to the MHRA.”

Lesley Briggs, a lay representative on the MESH working group and member of RCOG’s Women’s Voices Involvement Panel, said:

“This report is the culmination of a concerted effort by clinicians and patients to put into place changes so that current and future patients can expect high quality care when undergoing procedures involving mesh. Crucially there is now consistent and accurate information enabling each woman to enter into a dialogue with her doctor so she understands her condition, the treatments available – and the alternatives, what the treatment will entail and the risks associated with these procedures, enabling them to make an informed decision about their condition.”

The RCOG has created a Mesh webpage bringing together a number of resources to help support decision-making by women and healthcare professionals about the use of mesh.

ENDS

Notes to editors:

There are several treatment options available for both pelvic organ prolapse and stress urinary incontinence. These will depend on the severity of symptoms, a woman’s age and health, and whether she is planning to have children in the future.

Treatment options for both conditions include pelvic floor exercise and lifestyle changes, such as losing weight, eating a high-fibre diet, cutting down on caffeine and alcohol, and avoiding heavy lifting and standing for long periods.

If other treatments for urinary incontinence (including bladder training and medication) are unsuccessful, surgery may be recommended. Healthcare professionals may also suggest surgical repair, vaginal mesh and hysterectomy for women with pelvic organ prolapse, if local hormone treatment and vaginal pessaries don’t work.

 Transvaginal mesh is one of several treatment options available for pelvic organ prolapse and stress urinary incontinence. Surgical procedures using mesh devices may be appropriate and can be far less invasive that alternative surgical produces.

Evidence from the recently published UK PROSPECT study in The Lancet shows that mesh is a successful treatment for prolapse in most cases, and the majority of women treated with mesh respond well to this treatment. Unfortunately, there is also a risk of possible complications which include mesh erosion, infection and bleeding, and the strain of future pregnancies may cause the prolapse to recur. Pain and dyspareunia (painful sex) also occur after native tissue (non-mesh) prolapse surgery.

As part of the regular update programme, NICE is currently revising its guidelines on female urinary incontinence on pelvic organ prolapse and these are due to be published in 2019.