‘Paused’ mesh operations still being carried out at north Wales Health Board

Operations involving artificial vaginal mesh are still being performed at a north Wales health board even though the procedures were paused by the Welsh Government in 2018, Y Byd ar Bedwar has revealed.

In 2018, the Welsh Government announced that TVT and TVT-O operations, which involve inserting mesh to treat urinary incontinence in women, would be paused until a set of conditions to ensure that patients receive safe and high-quality care are met.

But S4C’s Y Byd ar Bedwar has revealed that 13 patients have had a TVT operation at Betsi Cadwaladr Health Board since 2018.

The programme asked every health board in Wales how many TVT or TVT-O operations they have performed between 2005-2025, and Betsi Cadwaladr University Health Board was the only one which confirmed patients had undergone these treatments since 2018.

In its response, Aneurin Bevan University Health Board said it did not have any data after June 2018, ‘as these procedures were paused indefinitely’.

The Welsh Government says vaginal mesh to treat stress urinary incontinence should only be used if there is no viable alternative and after close and comprehensive consultation between patient and clinician. Some procedures are allowed under certain circumstances and under high vigilance scrutiny arrangements, but this will be a clinical decision.

Responding to the figures, Dr Wael Agur, one of the top gynaecologists in Britain said he was shocked. He does private work  on behalf of the NHS in Scotland, and has given evidence in several legal cases against Betsi Cadwaladr health board which relate to vaginal mesh.

“I am very surprised. I did not expect a health board in the UK to be using mesh procedures for incontinence when there is an ongoing pause since 2018. I have stopped using mesh for over a decade now, for 12 years now I’ve stopped using mesh completely, and I have not come across any patient where the local team decided that her only option is the mesh for incontinence, the TVT or the TVT-O.”

“I don’t think this is the right thing to do – this is not the right way forward. The procedures TVT and TVT-O that are still being used at this health board are paused for a reason. And the reason is the long term debilitating complications that are avoidable because there are safer alternatives.”

Dr Clara Day, BCUHB’s Executive Medical Director, said: “Welsh Government and NICE guidance stipulates conservative and well-documented use of vaginal mesh procedures.

“In its ‘2021 exceptional surveillance of urinary incontinence and pelvic organ prolapse: management’, NICE stated TVT-O (tension-free vaginal tape-obturator): ‘should not be offered routinely. In the future, we feel the TVT-O should only be used in exceptional circumstances, if at all.’

“Since 2018 the health board has not undertaken any TVT-O procedures. In the same six-year period, 13 TVT (tension-free vaginal tape) procedures were completed.

“For management of urodynamically proven stress urinary incontinence, the use of TVT is only considered in the context of strict governance controls.

“These controls include using the NICE shared decision-making tool, formal Multi-Disciplinary Team approval to confirm appropriateness – and decisions require approval from the Executive Medical Director.

“Informed discussion with patients regarding the available treatment options, along with conversations around consent, are an integral part of this process.

“Patient outcomes are routinely recorded and monitored via the British Society of Urogynaecology (BSUG) database. Audits are also undertaken as part of our ongoing clinical governance.”

Watch the full investigation on Y Byd ar Bedwar, dan gyllell Klazinga.