Chamber and committees

Alternative treatment options to transvaginal mesh implants for vaginal prolapse include pelvic floor exercises, changes to diet to reduce weight, eating a high-fibre diet with plenty of fresh fruit, vegetables, wholegrain bread and cereal, the use of vaginal pessaries or a range of surgical techniques.

There are a number of treatment options available for stress urinary incontinence. These include changes to diet to reduce weight and physiotherapy to strengthen the pelvic floor muscles. Surgical treatment is recommended only if conservative (non-surgical) management is ineffective. There are a number of surgical procedures for this condition.

There have been no recent changes to the risk classification of Transvaginal Mesh Implants.

The consideration of clinical procedures including the use of ultrasound as a treatment in the removal of transvaginal mesh implants will be considered by the transvaginal mesh working group. This working group has been set-up to look in detail at issues surrounding transvaginal mesh implants. The next meeting of the working group will take place 13 December 2013.

The Deputy Chief Medical Officer met with Mark Lloyd Davies, Senior Director, Johnson and Johnson, and a colleague from the Association of British Healthcare Industry on 16 July 2013 to hear views on research and medical device regulations. There was no discussion on the suspension of the use of transvaginal mesh implants. A research paper was provided on biocompatibility for information.

This information requested is not held centrally. Information on the number of patients that have had to undergo multiple operations following a procedure to remove transvaginal mesh implants is not available as there are no specific clinical codes used to identify the removal of transvaginal implants.

However, available data shows that between 2007-08 and 2012-13, 15 of the 101 patients who had a procedure involving the removal of unspecified prosthesis from organ or the removal of other unspecified repair material from organ, were involved in a subsequent procedure during the year following treatment which could be related to the original removal procedure.

This information requested is not held centrally. Information on the number of procedures undertaken to remove transvaginal mesh implants is not available as there is no specific clinical codes used for this type of procedure. However, the following table provides information on the number of procedures for unspecified removal of prosthesis from organ or the removal of other unspecified repair material from organ that may include removal of transvaginal mesh implants:

Source: NHS National Services Scotland Information Services Division.

The Scottish Government is not considering suspending the use of transvaginal mesh implants.

Treatments are person-centred according to the individual needs of the child.

Each child is placed in the care of a dietician and is regularly reviewed in terms of dietary needs. Regular individual assessments take place and tube feeding will be reduced or ended as appropriate to clinical need, dependent on oral motor skills and sensory issues, whilst simultaneously increasing oral intake to ensure nutritional requirements are met at all times.

Multi-disciplinary teams are involved as appropriate, eg: dietetics, speech and language therapy, clinical psychology, paediatric gastroenterology, and the community children’s nurse. Teams encourage focussed food activities and feed time routines from an early age, taking into account the parental and family situation.

Priority is always given to return to oral feeding, where there is potential.

For those children who are physically able to eat but refuse to do so, a more intensive treatment plan will be developed involving sensory work around different textures of foods, a psychologist reviewing and assessing parent/child interaction at meal times, messy play and general faddy eater strategies.

This information is not held centrally.