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About mesh

‘Mesh’ is a term commonly used to describe a number of different types of devices that can be implanted into the body to support the body’s organs and other tissues.

This is done through a range of surgical procedures using different types of manufactured biological or synthetic implantable devices. In obstetrics and gynaecology (O&G), vaginal mesh is one option for the treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP).

In July 2018, a period of restriction was put in place regarding the use of vaginal mesh in England. This restriction was extended in 2019 and remains in place. For the majority of patients, mesh surgery should not be offered during this period of restriction. The period of restriction also includes all stress incontinence operations as well as insertion of abdominal mesh for pelvic organ prolapse.

First Do No Harm: The Cumberlege Report

In July 2020 the Independent Medicines and Medical Devices Safety (IMMDS) Review, chaired by Baroness Julia Cumberlege, was published. This addressed reports from patients of harm from drugs and medical devices, including vaginal mesh. The Royal College of Obstetricians and Gynaecologists (RCOG) and British Society of Urogynaecologists (BSUG) thank women for their courage in coming forward.

The RCOG and BSUG pledged to act on the recommendations within the report, to support trainees and specialists to learn from the report, and to provide the highest standard of care together with information to support women in their decision making for treatment for pelvic organ prolapse. Together with specialist centres, the RCOG is working to provide women who have had complications from mesh surgery with appropriate and safe treatment.

For some women, surgical procedures using mesh provide an effective form of treatment for the distressing effects of SUI and POP. However, some women experience serious complications and there are a number of patient communities who campaign to raise awareness of these concerns. No woman should be offered surgery using mesh without taking into account the restrictions as outlined above and without thorough and comprehensive counselling about the risks and benefits of mesh for their individual situation.

Current national guideline on urinary incontinence and pelvic floor organ prolapse management

The National Institute for Clinical Health and Care Excellence (NICE) guideline on urinary incontinence was reviewed in 2019 to take account of recent research into mesh, and expanded to include pelvic organ prolapse. The updated NICE guideline on urinary incontinence and pelvic organ prolapse in women: management was first published in April 2019 and last updated in June 2019. It was checked in February 2021 after the publication of the IMMDS Review, with no updates.

How do I know if I have had complications from a mesh procedure?

If you have concerns about complications as a result of vaginal mesh, you should inform your GP. Your GP will be able to refer you to a specialist mesh centre (see below for more information on these).

The Patient Safety Commissioner for England worked with patient groups and professionals, including the RCOG, to develop a letter for patients to download and bring to their GP to help discuss the next steps in their care if they have symptoms of mesh complications. Read this letter with more information about signs and symptoms.

Your doctor will report the complication to the Medicines and Healthcare products Regulatory Agency – this is to ensure the NHS has full details of the number and type of complications experienced by women across the country in order to make informed decisions about future guidance. You can also report complications yourself, directly to the Medicines and Healthcare products Regulatory Agency via their website, which also includes FAQs for members of the public.

Specialised services for mesh complications

NHS England is responsible for commissioning specialised services for women with complications of mesh inserted for urinary incontinence and vaginal prolapse. The first step in supporting patients with mesh complications linked to urinary incontinence and vaginal prolapse is to refer them to a specialised NHS England Complex Mesh Centre. These centres will provide management of continence and prolapse mesh complications, with the engagement of the multi-disciplinary team (MDT). This includes surgeons, physicians, imaging specialists, nurses, pain specialists, physiotherapists, and clinical psychologists in line with the published service specification. Each specialised centre treats women with complex mesh for a geographical region local to them. Find out more about the centres.

The RCOG’s Mesh Complications Management Training Pathway has been developed to equip doctors in commissioned regional specialised centres with the clinical and personalised care skills needed to needed to support, treat and care for patients experiencing mesh complications after surgery for urinary incontinence (UI), pelvic organ prolapse (POP) or rectal prolapse.

Further information

More helpful information for women can be found here:

The RCOG’s consent hub also provides guidance on how to support women to make informed decisions about their healthcare, obtain consent for procedures and discuss risks.

Information for GPs

Health Education England have designed a programme for GPs to provide up to date information about pelvic mesh complications and the services available, ensuring that women are assessed and referred to specialist services.

Support groups

Mesh UK Charitable Trust

Sling The Mesh