Transvaginal mesh short-life working group: report

Introduction

Prior to 2014, transvaginal mesh was in routine use in NHSScotland to treat both stress urinary incontinence (SUI) and pelvic organ prolapse (POP). In the ten years to 31 March 2016 there were 9478 primary single mesh operations for SUI and 599 for POP.^[1]

Concerns about the long-term impact of the use of vaginal mesh began to emerge in the mid 2000s and strengthened by the end of the decade. The first successful transvaginal mesh implant litigation in the US, in 2012, further highlighted the issues to the wider world. Women believed their symptoms had not been taken seriously and were suspected to be making things up. Mesh erosions were dealt with locally as they arose.

After meeting with a group of affected women in 2013, the then Scottish Government Cabinet Secretary for Health, Wellbeing and Sport asked that a Working Group be set-up to address the issues affecting women who developed transvaginal mesh complications. A public petition was lodged in April 2014. In June 2014, the then Cabinet Secretary for Health, Wellbeing and Sport requested a consideration of suspension of transvaginal mesh procedures in Scotland following which an independent review was established. At the time, there was already a significant decrease in the numbers of mesh operations being undertaken in NHSScotland.

The independent review published its final report in March 2017.^[2] Following the publication of the independent report, the Scottish Government asked Healthcare Improvement Scotland to establish a Transvaginal Mesh Implants Oversight Group (TVMO) with a remit to:

• review data on the use of transvaginal mesh implants in NHSScotland
• review adverse event reporting by NHS Boards
• consider how significant new evidence can be incorporated into the agreed NHSScotland pathways of care, and
• ensure that any patient information is up to date and appropriate.

In light of continuing concerns about the safety of vaginal mesh and representations from women affected, its use for SUI and POP was formally halted in NHSScotland in September 2018. At the same time, a high vigilance scrutiny programme was introduced to assure the treatment of women undergoing urogynaecology surgery. In each NHS Board an Accountable Officer has subsequently been assigned and is responsible for ensuring that the required high vigilance measures are applied in every case.