Date lodged: 31 March 2017
To ask the Scottish Government, further to the statement by the Cabinet Secretary for Health and Sport on 30 March 2017 (Official Report, c. 57), for what reason chapter six of the final report suggests that mesh procedures are better than non-mesh ones.
Answered by: Shona Robison 28 April 2017
Chapter 6 is a clinicians' review of the evidence and experiences noted elsewhere in the Report. Based on that evidence, it concludes that:
retropubic mesh tape is a valid option to be offered routinely to women considering surgical treatment for SUI;
colposuspension and autologous fascial pubo-vaginal sling are both appropriate alternatives for women who wish to avoid the use of a permanent implant, provided they accept the increased associated short-term morbidities and longer recovery, and increased long-term risk of prolapse following colposuspension;
women may wish to consider urethral injection therapy; they should be made aware that the efficacy is less than with other interventions, and decreases over time; hence the risk of re-admission for complications or re-operation for SUI is very much higher; and
in the case of pelvic organ prolapse, vaginal wall repair using native tissue (anterior and posterior colporrhaphy) should be the procedure of choice for women seeking surgery for POP; the use of polypropylene mesh or biological graft should not be offered routinely but may be considered in complex conditions – only after discussion at an appropriately constituted multi-disciplinary team.