Mesh has devastated thousands of lives across the UK. And it will continue to devastate thousands more unless its use in surgical procedures is banned.

According to the NHS, more than 127,000 women have received mesh and tape implants typically following childbirth. But that’s not including the thousands of other women, men and even children who have received mesh implants to treat other health issues like hernias, incontinence and prolapse, nor those who have had mesh inserted privately.

Despite its risks being widely publicised, the National Institute of Clinical Excellence (NICE) has today (2 April) issued revised recommendations allowing the continued use of mesh to treat stress urinary incontinence (SUI) and pelvic organ prolapse (POP).

Thompsons Solicitors is currently campaigning alongside Sling the Mesh to ensure that patients are no longer put at risk. We’re also representing hundreds of patients across the UK whose lives have been altered forever following mesh surgery.

If you have been affected by mesh, you are not alone. We can help you. Contact our medical negligence experts today for free advice on making a mesh claim.

Things you need to know about the revised NICE SUI and POP guidance

Why have new mesh guidelines been published?

In February 2018, the government established an Independent Medicines and Medical Devices Safety Review, led by Baroness Cumberlege following years of public concern over the safety of mesh implants.

In July 2018, Baroness Cumberlege reported an early finding of her Review to the Department of Health and Social Care. This called for a halt to the use of mesh by medical professionals to treat SUI and POP until six conditions were met. These can be found here.

New NICE guidelines were one of Baroness Cumberlege’s conditions – but they were only meant to follow on from at least four other pre-conditions that she set out having been met.

What health issues do the new NICE guidelines relate to?

The new guidance relates to stress urinary incontinence (SUI) and pelvic organ prolapse (POP).

What’s wrong with the new NICE guidelines?

Despite recognising public concern about mesh implants and risks associated with them, the guidelines will allow medical practitioners to treat SUI and POP with mesh.

The guidelines say non-surgical treatments must be explored before surgical options are offered to patients, but we fear this will be a ‘tick box’ exercise by medical practitioners, especially those who are pro-mesh.

The new recommendations will see patients remain dependent on varying advice from surgeons. Pro-mesh consultants will skirt around the risks widely recognised and will make a positive case for its use while surgeons who are more cautious will sit on the fence.  This will only put an immense amount of pressure on the patient having to make a decision (based upon the advice they get) but also upon the surgeon giving it.

The guidelines cover both the NHS and private medical institutions; however, there are a number of guidelines which do not apply to practitioners operating in the private medical sector. Private surgeons do not work in multidisciplinary teams (MDTs) and nor is there a requirement to add patient data to any registry (when it is established).

Mesh is already under a high level of scrutiny in Scotland, Australia and New Zealand.

In our view, these guidelines are not an example of ‘clinical excellence’, they are simply passing the buck.

The revised guidelines have been published before Baroness Cumberlege has reported the findings of her independent review into mesh – which means that, until she does, people who have mesh inserted may suffer long-term complications. If the revised guidelines are an indication of a consensus that mesh surgery is fine to continue we will, on behalf of hundreds of clients and alongside Sling the Mesh, challenge that in every way possible.

What does the new guidance mean for people who turn to their GP for help with SUI and POP in the future?

The sad reality is that people will continue to be put at risk as long as mesh surgery is an option. In the years to come if this advice stands, we can expect more lives to be devastated.

Thompsons is here to help those who have been affected. You needn’t suffer alone. We’re already representing hundreds of people across the country who have been placed in the same situation as you. Thompsons will fight your corner until justice is secured for your suffering.

Contact our mesh experts today by calling 0800 0 224 224 or by completing our free Start a Claim form.

I’m experiencing complications after having mesh surgery – what do I do?

If you are experiencing any of the symptoms widely publicised – such as severe pain, bleeding, difficulty walking or incontinence - we strongly advise you to contact your GP immediately. You should insist on your GP referring you to a hospital for tests to see if your mesh implant could be the cause of your symptoms. Separately, Thompsons Solicitors’ medical negligence lawyers can advise you as to whether you can make a mesh claim.

How can I help oppose these new recommendations?

Contact Sling the Mesh and campaign with them.

Join our call for the use of mesh implants to be banned by supporting our campaign, Patients Before Profits: Let’s help sling the mesh. We’re fighting alongside Sling The Mesh to ensure patient safety is prioritised over profits. No one should have to suffer the consequences of mesh.

What exactly do the new NICE guidelines on SUI and POP advise?

There are a number of new recommendations stated in the guidelines, but a summary of those most significant to mesh include:

Organisation of specialist services

  • All treatment for POP and SUI must be reviewed by local multidisciplinary teams (MTDs).
  • An MTD must comprise two consultants with experience in urinary incontinence, including urogynecologists, urologists, pelvic floor experts, physiotherapists, a colorectal expert and experts in geriatric medicine where necessary.

Collecting data

  • The details of those who have received surgery for SUI or POP, or who have experienced complications as a result of these types of surgery, must be recorded in a national database.

Assessing urinary incontinence

  • In all cases, there must be a physical examination of the pelvic floor muscles, urine testing, symptom scoring and a quality of life assessment. Patients should be encouraged to keep a bladder diary. Other matters which might be useful are pad testing, urodynamic testing and if necessary, more invasive tests.

Non-surgical management

  • Non-surgical management should be recommended. This can include:
    - Eliminating caffeine;
    - Losing weight;
    - Modifying fluid intake;
    - Trialling a period of physiotherapy and pelvic floor exercises;
    - Physical therapies including pelvic floor stimulation, electrical stimulation and neuro-stimulation; and
    - Medication, during which the use of catheters and towels should be considered along with medication and checked on a four-weekly basis.
  • Invasive procedures should only be considered where the woman has not responded to non-surgical management. This involves:
    - Urodynamic investigations (to test how the bladder is working);
    - Botulinum toxin injections (such as botox);
    - Sacral nerve stimulation;
    - Augmentation cystoplasty (to make the bladder bigger); and
    - Urinary diversion (surgery that reroutes the normal flow of urine out of the body when the normal flow is blocked).

Surgical management

  • Practitioners must use a NICE patient decision sheet for surgery and a discussion with the patient on the risks and benefits of all surgical options should take place before proceeding.
  • Practitioners must offer the following alternative surgeries:
    - Colposuspension
    - Fascial sling
    - Mid-urethral sling (If this includes mesh, the name of the manufacturer must be supplied to the patient. It must be made of macroporous polypropylene. It must be of a high colour for ease of insertion and revision)
    - Practitioners must not use the transobturator approach
    - Practitioners must not use the ‘top-down’ approach
    - Intramural bulking agents, which increase the volume of the urethral wall, can be offered if surgical management is not appropriate
    - Practitioners should follow-up with patients after surgery and offer a six-month appointment
    - For retropubic mesh surgery, there must be a vaginal examination and a further referral for recurrent symptoms
    - Practitioners must provide access to further assessment if surgery has failed.

Assessment of POP

  • A patient’s full medical history must be taken
  • An examination must take place to assess the pelvic mass
  • The case must be dealt with by an expert in prolapse to:
    - Assess the severity of the problem
    - The strength of the pelvic floor muscles
    - Assess vaginal atrophy.

Non-surgical management of POP

  • The practitioner must discuss management options with women who have POP, taking into account:
    - Lifestyle
    - Age
    - Previous procedures
    - Losing weight
    - Minimise heavy lifting
    - Practitioners must treat constipation, manage menopausal symptoms and pelvic floor muscle training must be considered.

Surgical management

  • Surgery should only be offered where other methods have failed
  • If the patient only has a prolapse and does not suffer from incontinence, surgery for incontinence should not be offered
  • Surgical options are:
    - Hysterectomy
    - Vaginal hysteropexy with sutures
    - Manchester report (not suitable for women of childbearing age).