Female Pelvic Mesh Service

The reason for the pause is to enable health providers to take steps to minimise harm linked to the procedure, which will result in better outcomes for patients who have mesh inserted as part of their incontinence treatment. Please note: this is the only surgical mesh procedure that has been paused.  

Patients who are directly affected by this decision, including those currently waiting for a stress urinary incontinence procedure which may include mesh insertion, have been, or will shortly be contacted by their local Health NZ District Hospital to discuss their ongoing management plan. Those receiving treatment in a private facility can expect to be contacted by their clinician.  Each plan is likely to be different depending on individual circumstances but could range from additional non-surgical management (e.g., pelvic floor physiotherapy), to a different surgical procedure or to wait until the pause is lifted. 

People needing to know more can find information on the Manatū Hauora website, or talk to their GP or specialist. 

For all other information regarding the New Zealand Female Pelvic Mesh Service please continue below.

We care about women's health

Health NZ acknowledges the extreme pain and distress caused to women who have experienced complications as a result of pelvic mesh surgery. The New Zealand Female Pelvic Mesh Service is a holistic and wraparound service that has been established to support and care for women who have suffered injury from having pelvic surgical mesh put into their bodies during surgery.

It has been designed in partnership with mesh-injured consumers, Māori and Pacific health representatives and medical professionals, and in collaboration with ACC. Specialist surgeons, specialist nurses, physiotherapists and pain specialists were also involved.

A women’s choice is at the centre of this service. Your journey with us starts with understanding your experiences, needs and goals. The Navigators and Nurse Specialists will support you every step of the way.

Treatment and care options will be discussed with you. The service will work with you to develop your individual treatment and care plan, and treatment will only be provided if you agree.   

Care and support options include: 

• continence care 
• pain management
• physiotherapy
• psychologists
• surgery
• cultural and language support
• spiritual support.

If you need to contact us you can use this email address.  Please note that due to clinical commitments that the team aim to respond within 2-working days. nzfpms@tewhatuora.govt.nz

Updates on waiting times

We understand that waiting for an appointment can be concerning.

We are happy to advise that the measures taken to shorten the previously extended wait times for initial contact with our health team have been successful. Our current wait times are now comparable to other Health New Zealand services.

Referrals to our Service are carefully reviewed and prioritised. You will receive a letter with details on when you can expect to be contacted by a member of our health team. Please note that waiting times may vary depending on the urgency of your condition and staff availability. The longest you can expect to wait is 4-months. 

If you are worried that you have been forgotten, or that you haven’t heard from someone in the team for a while and want to connect with us, you can contact the team on nzfpms@tewhatuora.govt.nz, call the number on your referral acceptance letter or ask your GP practice to call the team for a clinical update.

Thank you, we do appreciate your patience.

The Service will be based in two locations - Ōtautahi (Christchurch) and Tāmaki Makaurau (Auckland). Not all appointments or assessments will need to be held in these physical locations. Phone or video consults will be available as appropriate. If you are required to attend an appointment or assessment in person, travel and accommodation expenses may be covered for yourself and a support person.

The Health Navigator will help connect you with the National Travel Scheme to assess your eligibility, or if you may be eligible for travel assistance as part of having an ACC claim accepted.

The service reflects recommendations from the 2019 restorative justice project on surgical mesh:

Hearing and Responding to the Stories of Survivors of Surgical Mesh - Ministry of Health

If you are experiencing symptoms you think may be related to pelvic mesh, please talk to your GP or specialist about being referred to the New Zealand Female Pelvic Mesh Service.

If you are a GP or specialist and need to contact us, please use this email address nzfpms@tewhatuora.govt.nz

See your local HealthPathways for further information about the service and how to send an electronic referral.

How it works

If your referral is accepted you will be contacted by a member of the team, this may be to set up appointments to meet the Navigator, Nurse Specialist or doctor, or it may be to ask some questions that help the team plan any investigations that may be needed.

Patients will be offered the opportunity to share their journey and experiences since surgical mesh was implanted.  Capturing your journey helps the team understand your needs and experiences, and guide them on potential ways to help you, and what matters to you. 

Our multidisciplinary team will work through treatment options that may suit your situation and work on a treatment, care and support plan, to discuss with you. You will be invited to an appointment where treatment and care options will be discussed with you. Surgery, to remove the mesh and/or repair damaged tissue, may be discussed with you as part of your treatment plan, however, for some people surgery may not be the best option. The service will work with you to develop your individual treatment and care plan, and treatment will only be provided if you agree.

You will continue to be looked after by the New Zealand Female Pelvic Mesh Service until you and the clinical team agree that the treatment goals you and the surgeon agreed for you have been met.

If it is determined that you have an injury caused by pelvic mesh, the team will work with you to submit a claim to the Accident Compensation Corporation (ACC).

Consumers who have had any of the following pelvic mesh procedures and are eligible for New Zealand health care or ACC can be referred to the New Zealand Female Pelvic Mesh Service:

• All pelvic mesh inserted for pelvic organ prolapse (POP)
• All pelvic mesh inserted for stress urinary incontinence (SUI)
• Pelvic mesh inserted for rectal prolapse (rectopexy) if another type of pelvic mesh for either POP or SUI was also inserted. If only rectopexy mesh was inserted you will be referred to a colorectal specialist instead.

Mesh used for hernia repair in the pelvic region is not currently included in this service.

Note: You can access the New Zealand Female Pelvic Mesh Service if you are eligible for publicly funded health and disability services in New Zealand or if your GP or specialist believe your mesh complications may be covered by ACC as Treatment Injury ACC. 

For more information see pelvic mesh injury on the ACC website.

Rectopexy mesh treatment injuries are assessed and managed within general claim management at ACC. Treatment injury claims are assessed on a case-by-case basis regarding the client’s needs.

If you have Rectopexy mesh only and believe you might be experiencing symptoms that are related to a complication, you may find more information about ACC support and the client journey here:

• Help for pelvic mesh injuries: Pelvic mesh injury (acc.co.nz)
• Surgical mesh report: ACC taking action to improve client experience and health outcomes
• Treatment Injury Guide: 855206-ACC7972-TI-claim-guide-Mar2019-Pr08.indd

• After your referral is accepted you will be contacted by a member of the team, this may be to set up appointments to meet the Navigator, Nurse Specialist or doctor, or it may be to ask some questions that help the team plan any investigations that might be needed.
  We understand that it can be frustrating and traumatic to constantly be asked to repeat your journey with every new health person. To reduce the potential of this happening, we offer all patients the opportunity to capture their journey and experiences. Sharing your experiences like this is optional, choosing not to share it in this way will not impact your care. If you decide to proceed a Health Navigator will contact you to explain the process, give you options on how to do it and what happens when they document it for the health team, they will explain how it happens.Once it is written up you will be asked to read it and make any corrections or additions and it will be entered into your medical records so people involved in your treatment will be familiar with it and you won’t have to keep retelling it.

• The Health Navigators role is to support you every step of the way as you journey through this service. Our navigators are based in both centres, and work with women from all over the country.

• The GP or specialist who has referred you, will have sent through any relevant medical records with your referral. It may be determined that some additional investigations are needed to be able to help prioritise the care that you need. If this is the case, these will be discussed with you and booked as appropriate. Some people may be eligible for National Travel Assistance or for assistance as part of having an ACC claim accepted to travel for these investigations. A member of the team will talk to you about this.

• You are encouraged to have a support person with you for all appointments, including phone and video appointments. If you can’t bring someone with you, the Health Navigator can support you if you wish.

• Ensuring you have access to cultural, spiritual or language support throughout your journey with the Service is important. If at any time you would like us to arrange a person to support you with this, please ask the Health Navigator.

• It is important that we gather the right information to help understand your situation. Once we have that, the multidisciplinary team, which may include a combination of credentialled surgeons, specialist nurses, pain specialists, physiotherapists, social workers, psychology services and occupational therapists, will get together to discuss your case. They will work through treatment options that may suit your situation and work on a treatment, care and support plan, to discuss with you. You will be invited to an appointment where treatment and care options will be discussed with you. Surgery, to remove the mesh and/or repair damaged tissue, may be discussed with you as part of your treatment plan, however, for some people surgery may not be the best option. The service will work with you to develop your individual treatment and care plan, and treatment will only be provided if you agree.

• The service ensures best care through regular Multidisciplinary Team Meetings (MDM), where your medical history is reviewed, and treatment options are discussed and agreed by a team of doctors, nurses, and allied health professionals skilled at managing complications from surgical mesh.  The team discusses and proposes an individual treatment plan based on established medical guidelines and current evidence that has been thoroughly researched and published, where there is an absence of research best practice guidelines are applied. Best practice guidelines are established and widely accepted methods or protocols to achieve safe optimal outcomes, they are based on extensive experience, expert consensus, and evidence from various sources.   This approach ensures all treatment options are considered and tailored to your goals. All participants adhere to confidentiality agreements, and the process complies with the Health Information Privacy Code and the Privacy Act 2020.

  The Patient Information Guide to MDM has been developed with mesh injured consumers, to help you understand this important step in your health journey.

• You will continue to be looked after by the New Zealand Female Pelvic Mesh Service until you and the clinical team agree that the treatment goals you and the surgeon agreed for you have been met.

If you have complications related to pelvic surgical mesh, you can access this new service from anywhere in Aotearoa New Zealand.  

The New Zealand Female Pelvic Mesh Service will be based in two locations:

• Ōtautahi Christchurch
• Tāmaki Makaurau Auckland

Treatment may also be provided at other locations where team members are based. 

Not all appointments or assessments will need to be held in these physical locations. Phone or video consults will be available as appropriate. If you are required to attend an appointment or assessment in person, travel and accommodation expenses may be covered for yourself and a support person.

Surgical mesh is a medical device used to repair and provide support to parts of your body that have become weakened. Pelvic mesh is a type of surgical mesh. It is a synthetic implant that is made from a non-absorbable polypropylene (plastic) material. It is known by multiple names including tape, sling, TVT, patch, ribbon, graft or hammock. A mesh implant is used to support and hold your urethra, similar to the function of ligaments that are weakened in the case of incontinence. It will stay in your body permanently as it is non-absorbable. 

Transvaginal mesh was previously used to repair pelvic organ prolapse (POP) prior to 2017, however regulatory action in 2017 banned its use in New Zealand. Abdominal surgical mesh is currently used in New Zealand to treat pelvic organ prolapse and rectal prolapse.

Some people have pelvic mesh implants with no complications and good outcomes. However, this is not true for everyone. Some people suffer complications leading to injuries which can be anywhere from minor to serious and life-changing. An added complication is that harm from pelvic mesh can cause symptoms immediately following surgery, or it can be years down the track before any symptoms start. Some of the possible pelvic mesh-related complications include:

• Erosion is where mesh pushes against and into the surrounding tissue, nerves and organs. Erosion can occur years after surgery with the most common being erosion into the vagina.
• Extrusion is where mesh pushes through or perforates surrounding tissue, nerves and organs including the bladder, urethra or bowel.
• Infection of damaged tissues, with recurrent urinary tract (bladder) infections being the most common.
• Inflammation caused because the mesh is a foreign body that activates an immune response.

All of these complications can result in acute and/or chronic pain as well as other symptoms.

Restorative Justice process 

In 2019, Manatū Hauora - Ministry of Health led a process to hear directly from New Zealand people affected by implanted surgical mesh. This programme focused on anyone who had been impacted by injury and harm from the insertion of surgical mesh in Aotearoa.

The restorative justice project heard numerous stories from women with complications.

These were independently analysed by a team from the Diana Unwin Chair in Restorative Justice, Victoria University of Wellington, and resulted in the report Hearing and Responding to the Stories of Survivors of Surgical Mesh.  

This report describes significant harm with extensive impact on quality of life for the women and whānau affected.   

New specialist service among the action points

The report highlighted 19 recommendations and action points. The establishment of a specialist service to assess and deliver treatment options for consumers suffering from post-mesh implantation complications was Action number 8. 

The New Zealand Female Pelvic Mesh Service is for those women and their whānau living with complications.  

Manatū Hauora - Ministry of Health contracted the then Northern and Southern region District Health Boards to scope and co-design, with consumers harmed by surgical mesh, options for the delivery of these services. The services needed to be nationally consistent, consumer-centred, high quality and accessible to everyone, with barriers to treatment removed. 

A credentialling framework has also been created for surgeons who offer treatment for consumers experiencing complications associated with implanted mesh.

A global issue 

A similar process to remediate people suffering from pelvic mesh complications has been undertaken in Australia and the UK.

Surgical mesh is a worldwide issue and has caused avoidable harm to hundreds of thousands, and possibility millions of people. Opinions in the medical industry are contentious and divided and use of mesh continues today around the world.   

You are not alone 

Many women have struggled with complications from the use of surgical mesh in operations. 

They have shared their often painful stories in the ‘Hearing and Responding to the Stories of Survivors of Surgical Mesh’ report, part of the Restorative Justice Project to address the sometimes poor outcomes to their surgery. 

Those stories and their voices have created a powerful chorus for change. Te Whatu Ora and others have listened and worked with them to create an action plan to make those changes happen.