Vaginal Mesh Implants

Surgical mesh is a material that can be used to treat pelvic organ prolapse and stress urinary incontinence. Mesh is made from a non-absorbable material that remains in the body as a permanent implant.

The majority of women have a good outcome from vaginal mesh procedures. This surgery is completed on millions of women worldwide with the majority of people reporting an improvement in symptoms and no side effects.

However, some women have suffered complications. Some of these complications include chronic pain, mesh exposure or erosion and infection.

Signs and symptoms of a vaginal mesh complication

Pain that is not improving – low abdominal, pelvic, groin, thigh or buttock pain
Poking or prickling sensation or spasms in the pelvic area
You or your sexual partner feeling the mesh through the vaginal wall
Pain (either you or your sexual partner) during sexual intercourse
Abnormal vaginal bleeding or discharge
Difficulty with bladder emptying
Pain associated with urination
Recurrent bladder infections
Abscess or swelling at the mesh insertion or exit site

Experiencing problems with your vaginal mesh

If your vaginal mesh is causing signs or symptoms of a complication further assessment and any additional treatment can be undertaken by an experienced urogynecologist or urologist who specialises in pelvic surgery.

As part of the process, assessment and treatment options specific to your circumstances should be discussed and tailored to your symptoms and concerns.

If you had your surgery and are a public patient contact your hospital group for more information. Please be assured that all information is treated confidentially. You do not need to include personal details about your procedure in your email. A nominee from the hospital group will respond to your query and advise on the most appropriate pathway for you.

Ireland East Hospital Group:IEMESHpathways@nmh.ie

St. Vincent’s University Hospital
Wexford General Hospital
Regional Hospital Mullingar
National Maternity Hospital

Dublin Midlands Hospital Group: meshenquiries@coombe.ie

The Coombe Women & Infants University Hospital
Midland Regional Hospital Portlaoise
St. James’s Hospital
Tallaght Hospital

South/South West Hospital Group:SSWMESH.pathways@hse.ie

Cork University Maternity Hospital
Kerry General Hospital
South Tipperary General Hospital
University Hospital Waterford

University of Limerick Hospital Group:ULHGMeshPathways@hse.ie

Mid Western Regional University Hospital Limerick
St. Johns Limerick

Saolta Hospital Group:SaoltaMESHpathways@hse.ie

University Hospital Galway
Portiuncula Hospital
Sligo University Hospital
Mayo University Hospital

RCSI Hospital Group:coo@rcsihospitals.ie

Connolly Hospital
Beaumont Hospital

Treatments for vaginal mesh complications

Treatment is dependent on what is found at your assessment, medical factors and your expectations.

Treatment options include:

Bladder and/or pain medications
Expert physiotherapy
Pain management strategies
Psychological support
Targeted partial removal of mesh
Full removal of mesh – in specific circumstances

I am not experiencing problems with vaginal mesh but am worried

Given the recent coverage of mesh devices it is natural to have some concerns.

This surgery is completed on millions of women worldwide with the majority of recipients reporting an improvement in symptoms and no side effects.

The mesh device itself is considered safe and is approved by the relevant regulatory authority and endorsed by all the major national and international professional associations.

Removing the mesh without due cause is unnecessary, potentially dangerous and not recommended.

If you have any concerns we would advise you to contact your Consultant’s clinic or discuss with your GP.

Please note that not all surgical treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) involves the use of mesh.

Awaiting a mesh procedure

If you have any concerns about your upcoming surgical procedure we advise you to speak to your treating Consultant.

No treatment will be completed without your fully informed consent.

Having no surgical intervention is always a treatment option.

Common questions

Why was the use of mesh paused?

On July 26th 2018, at the request of the Chief Medical Officer (CMO) in the Department of Health, the HSE placed a “pause” on the use of mesh for urinary stress incontinence and pelvic organ prolapse surgeries in Irish public hospitals, in cases where it is clinically appropriate and safe to do so. The CMO requested that the pause remains in place until the HSE completes the implementation of new recommendations.

These recommendations relate to informed consent, an accreditation system and the development of a national mesh register. This action was considered necessary to provide public assurance that the use of mesh, for these purposes, is in line with international best practice.

It is important to note that there has been no change in the evidence about the use of mesh which continues to be endorsed by all major national and international professional associations. The mesh device itself is considered safe and is approved by the relevant regulatory authority. It is widely accepted that for many women suffering the distressing symptoms of stress urinary incontinence in particular, surgical procedures using synthetic mesh devices have provided a more effective and less invasive form of treatment than traditional surgical procedures.

If you have had a mesh implant there is no need to be alarmed. If you are like most women who have had this surgery you will have seen an improvement in the symptoms that lead you to the surgery. If you are experiencing problems please be assured that the clinical expertise to deal with all mesh complications exists in our hospitals and access can be arranged via the email contacts provided on this information page.

What is surgical mesh?

Surgical mesh is a man-made (synthetic) non-absorbable material, usually polypropylene, that remains in the body as a permanent implant. Surgical mesh is used to provide additional support during the surgical repair of weakened or damaged tissue. Surgical mesh is a material that can be used to treat pelvic organ prolapse and stress urinary incontinence, amongst other conditions.

What is vaginal mesh?

Vaginal mesh is one type of surgical mesh. It is used to treat two different health issues in women:

Stress urinary incontinence
Pelvic organ prolapse

The use of mesh implants in uro-gynaecological and urological procedures has been standard clinical practice since the late 1990’s. Urogynaecological and urological mesh devices can also be called “sling” “tape” or “ribbon” - these are all “mesh”.

What is Stress urinary incontinence (SUI)?

Stress Urinary Incontinence is the leakage of urine during activities such as coughing, sneezing, lifting, laughing or exercising. It affects up to 20% of women. Whether you leak a small or large amount of urine, stress incontinence can be embarrassing and distressing. It is caused when the supporting tissues of the bladder neck and urethra lose their natural support and cause accidental loss of urine. Stress incontinence has many causes including pregnancy, childbirth, obesity, chronic cough, constipation, heavy lifting and genetically inherited factors.

What happens during surgery for stress urinary incontinence?

This operation involves placing a sling (a strip of mesh) underneath the urethra (the tube through which you pass urine). This sling supports your urethra when you laugh, sneeze, cough or are physically active and so prevents urine leaking from your bladder.

What is pelvic organ prolapsed (POP)?

POP is a condition where a woman’s vaginal walls and pelvic organs (uterus, bladder and bowel) lose natural support, which causes them to bulge down within, and sometimes outside of the vagina.

What happens during mesh surgery for pelvic organ prolapse?

A variable quantity of mesh, tailored for each individual patient, is used to provide durable reinforcement to the weak vaginal wall tissues.

Is there a difference between using mesh to treat stress urinary incontinence and pelvic organ prolapse?

The same material is used in both but the surgery differs in the method, site of mesh placement, amount of mesh used and risks.

Are slings and tapes made from the same material as mesh?

A ‘sling’ or ‘tape’ used in pelvic procedures are produced from a woven synthetic netting usually made from polypropylene. This is the same as ‘mesh’ – all terms refer to the same type of product.

What if I want all my mesh removed?

The expertise required for mesh removal exists currently in our health service and mesh removals are carried out, in specific circumstances, in our public health system. When considering mesh removal there needs to be a thorough assessment of the complications being experienced and the likelihood of mesh removal addressing those complications. When considering mesh removal there needs to be an individualised balance struck between the risk of further complications associated with the mesh remaining, compared with the risk of complications from any removal procedure, and also, the possibility of complications remaining with the mesh removed. Mesh is intended to be a permanent implant and removing the mesh without due cause is unnecessary, potentially dangerous and not recommended.

Chronic pain can propel people to take drastic measures in order to gain relief. We would ask patients in such situations to engage with the system and allow us to help find the appropriate pathway for them in terms of treatment and pain relief.

What if I had my treatment done privately?

If you were a private patient and have concerns about your mesh you can contact your treating Consultant or hospital. Alternatively, you can request a referral into the public system from your GP.

The HSE Mesh Complications Service

If you are having problems with your vaginal mesh implant you should return, in the first instance, to the Consultant who completed your surgery to discuss the problems you are having and the remedies available.

The HSE Mesh Complications Service has two sites – The National Maternity Hospital (Holles Street) in Dublin and Cork University Maternity Hospital.

If you are unable to return to your treating Consultant (for reasons such as they have retired) your GP can refer you to the HSE Mesh Complications Service.

Additionally, if the complexity of your care is such or if you have not responded to remedies by your treating Consultant, you may be referred to the HSE Mesh Complications Service.

You, your Consultant or GP can contact the National Mesh Administrators at:

The CUMH Site: SSWMESH.pathways@hse.ie

The National Maternity Hospital (Holles Street): IEMESHpathways@nmh.ie

Please note the National Mesh Administrators do not give out clinical advice. Referrals and recommendations on the treatment required will only be made by a Consultant. Appointments cannot be facilitated without a letter of referral.

Reporting of Vaginal Mesh Implant Adverse Incidents

The HSE wants to ensure that all vaginal mesh implant adverse incidents are reported, assessed and collated. Therefore the National Women and Infants Health Programme (NWIHP) have linked with the HPRA to issue specific instruction on reporting such incidents.

The Health Products Regulatory Authority (HPRA) is the competent authority for medical devices in Ireland. It closely monitors potential issues with medical devices by using a vigilance system to protect the health and safety of patients, users and others.

This is achieved by:

evaluating vigilance reports received from manufacturers
healthcare professionals and members of the public providing information to users on the safe use of medical devices
evaluating an action for the market place - device recall or device modification (where appropriate)
receiving adverse incident reports from both healthcare professionals and the public

If you would like to report a vaginal mesh implant adverse incident please follow the HPRA step by step guidance on reporting (PDF, 233 KB, 2 pages).

Read Healthcare professional guidance on reporting of vaginal mesh implant adverse incidents (PDF, 386 KB, 1 page)

Additional information is available on the HPRA website.