Mesh procedures remain paused – HSE

A HSE pause on mesh procedures remains in place until all recommendations of the uro-gynaecological mesh implementation plan are implemented. Eleven recommendations are completed and eight are ongoing, according to the Executive.

In July 2018, Department of Health Chief Medical Officer (CMO) Dr Tony Holohan requested that the HSE pause all uro-gynaecological mesh procedures where clinically appropriate. The request was made in order to address concerns about the ongoing safety of mesh devices.

A report by the CMO in November 2018 referred to an “extensive evidence base” supporting the use of mid-urethral sling devices in the treatment of stress urinary incontinence (SUI) and abdominally placed mesh in the management of pelvic organ prolapse (POP). However, trans vaginal placement of mesh for treatment of POP was “no longer regarded as appropriate first-line treatment”.

“Mesh devices are associated with significant and severe complications in a minority of women, which are of concern given the difficulties of mesh implant removal.”

The CMO’s report made recommendations in relation to patient information, professional standards of practice, as well as research and audit.

The HSE will advise the CMO when the recommendations are addressed.

According to an update from the HSE National Women and Infants Health Programme to the Department’s National Patient Safety Office in January, consent processes had been developed for female SUI and trans abdominally placed mesh for POP. “We are not seeking to reinstate trans vaginally placed mesh for the primary treatment of pelvic organ prolapse at this juncture.”

In 2020, the HSE allocated €500,000 to Cork University Maternity Hospital and €535,988 to the National Maternity Hospital for provision of post-mesh complications services nationally. The HSE said it could not extract information on the number of referrals.