Scottish Independent Review of the use, safety and efficacy of transvaginal mesh implants in the treatment of stress urinary incontinence and pelvic organ prolapse in women April 2017

12th April 2017

The Scottish Independent Review of the use, safety and efficacy of transvaginal mesh implants in the treatment of stress urinary incontinence and pelvic organ prolapse in women

Final Report March 2017 has now been published and can be accessed HERE The review highlights both positive and negative aspects in relation to vaginal mesh usage for the treatment of stress urinary incontinence and prolapse. In line with other reports produced it separates out treatment of stress incontinence from treatment of prolapse.

The report emphasises the following which we feel that the BSUG membership should be fully aware of:

Ensuring that patients are clear about all the different treatment options.
This is in line with the Montgomery ruling and GMC guidance and must include the option of doing nothing and also conservative measures.

Working in an MDT.
This is in line with modern practice and is art of the working practice required for BSUG accreditation of units.

Reporting adverse events.
Again demonstration of this is part of BSUG accreditation as is data entry onto the database.

This is also required for the GMC and forms part of the duty of candour.
Unit identification on the BSUG database for the removal of mesh requires data to be entered into the BSUG database and MHRA reporting.

Importance of informed consent.
This is supported by BSUG. The governance committee are working with members to produce information leaflets for all aspects of urogynaecology care.

The leaflet endorsed by NHS England and Scotland and RCOG and BSUG for tapes in now recommended for use when women are considering a mesh tape for the management of incontinence.

Lack of research regards outcome data.
If all members were to use the database then there would be a very large cohort that could inform practice moving forward.
They also identify difficulty in coding as poor coding or lack of appropriate codes makes data collection and analysis difficult.

Recommendation of retropubic tape rather than the obturator technique where a mesh tape is to be used for the treatment of stress urinary incontinence.

This is not in line with current Nice guidance.
The Nice review is currently underway and the document related to management of incontinence and prolapse is due in 2019.

Mesh for management of prolapse should not be used in primary treatment and its use should be undertaken only after MDT discussion.
Again it is not for BSUG to direct clinical practice and we await the new Nice guidance. BSUG accreditation requires MDT working.

We would encourage reading the report as it helps inform practice and highlights areas that members should be aware of. The findings are applicable to practice in the whole of the UK and not just Scotland.