MP calls it a 'welcome U-turn' but Sling the Mesh say it's too little, too late after health watchdog issues fresh guidelines on pelvic mesh implants
PUBLISHED: 00:01 09 October 2018 | UPDATED: 11:28 10 October 2018
New guidelines on how to treat women suffering incontinence or prolapse do not go far enough to protect patients, campaigners warn.
They also say women who have been used as guinea pigs for implanting mesh, must not be now used as guinea pigs for mesh removal, and all consultants attempting this complex surgery must be properly trained.
In addition, mesh should only be offered as the last chance saloon, once everything else has failed, they say.
Health care watchdog, NICE, has issued draft guidelines which say women should be offered a full range of treatment options for incontinence or prolapse before choosing surgery.
But NICE says mesh can still be offered as the second option.
Campaigners say it must only be offered as the final, third option, once natural solutions like physiotherapy have failed and once traditional surgery has also failed.
Under the new guidance, a national registry will be launched which means every woman choosing mesh in the future must be logged on a database.
Owen Smith MP, chairman of the All Party Parliamentary Group on surgical mesh, said: “This is a welcome U-turn from NICE, who in their 2016 guidelines for mesh did not recommend any other treatment options for SUI and in fact stated that complications from mesh were ‘infrequent’.
“While I am pleased that NICE is now taking action to advise against mesh as a first-line treatment, this announcement is well overdue.
“I have called on them to get on and urgently publish these guidelines for the last two years and I’m glad they have finally listened.
“This news is also a complete vindication of the thousands of women injured by mesh surgery who have campaigned tirelessly to get the procedure halted.
“I believe that the announcement of these guidelines, along with the Department for Health’s current suspension of mesh surgery, will mean the end of mesh surgery for incontinence other than for a handful of women for whom all other options have been ruled out.”
Kath Sansom, of Sling The Mesh, said: “These draft guidelines do not go far enough.
“Mesh should only be offered as the very last option, to ensure only the smallest number of women are exposed to mesh risk.
“This is being recommended for Scottish women.
“Ideally we want all pelvic mesh stopped. The risks are too great. It is totally unacceptable that women come out of a “simple little operation” with shattered lives.
“One in seven women in Sling The Mesh have lost their marriages because of mesh. Seven in 10 have lost their sex life. Eight out of ten suffer pain so great it affects their daily life.
“More than half suffer ongoing urinary infections. Not surprisingly many are suicidal and six in ten are on anti depressants.
“Sling The Mesh has nearly 7,000 members. Sadly many thousands have been harmed in the last 20 years. This guidance should have come a long time ago.”
Surgeon Wael Agur said: “In Scotland mesh tape for incontinence is being recommended to be restricted to the most remote circumstances after failure of all options, both non surgical and surgical. This policy needs to be the same both north and south of the border.”
Surgeon Suzy Elneil said: “The new NICE directive is going back to basics, where the focus is on non-surgical approaches to care which should have always been the case.
“Mesh, should it really be required, should be the very last resort. It should also go hand in hand with robust counselling and consent processes, and patients should be warned that is it is not a lifelong solution.
“But perhaps what one should really be driving at is prevention of the problem in the first place. We should advocate for pelvic floor care from an early age, thus preventing the need for surgery in the majority of cases.”
Linda Millband, head of medical negligence at Thompsons Solicitors, acting for more than 280 mesh clients, said the guidelines are: “A step in the right direction, however our concerns remain that private hospitals will ignore these guidelines in the same way they have failed to implement the pause on mesh surgery that the government has imposed on the NHS.
“The real answer is for the government and NICE to stop making small amendments to guidance and issue an absolute ban on mesh use until it’s risks are fully investigated, and patients can be confident about its safety.
NICE says there are a number of non-surgical options for urinary incontinence and pelvic organ prolapse, which should be considered before surgery including lifestyle interventions, pelvic floor therapy and medicines.
Sir Andrew Dillon, chief executive of NICE, said: “It is important that every woman is supported to make decisions that are right for her, consents to a procedure, and fully understands the benefits and risks of the procedure being offered before consenting to it.
“Where surgical mesh/tape could be an option, there is almost always another intervention recommended in our guideline, which does not involve surgical mesh/tape.”
Where surgery is offered, if a woman’s chosen surgery is not available from the consulting consultant, she should be referred to an alternative medic.
Where it is agreed to use surgical mesh/tape, women must be fully informed of the risks.
In July a national mesh suspension was announced by the government.
This will remain in place until a number of conditions are met including a national database and specialist surgeons at specialist centres.
Complications must be reported to the Medicines and Healthcare products Regulatory Agency (MHRA) and details collected in a national registry.