About our service

A new national service has been established to support and care for women who have suffered injury from having pelvic surgical mesh put into their bodies during surgery.

For the purposes of this service the word female refers to individuals born with female pelvic organs (vagina, uterus and ovaries). It does not make any judgement about whether individuals identify as male, female or non-binary.

Where the word consumer or women/woman is used in these pages we are referring to individuals who are female, as described above.

 

We care about women's health

Te Whatu Ora 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 within the service will start with Pauline or Tiffani, our Health Navigators, whose role is to 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.

 

Where we are

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.  

How to access the service

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.

How it works

If your referral is accepted you will be contacted by the Heath Navigator to ask you some further questions about your journey and experiences since your surgical mesh was implanted. These questions will help the team understand your needs and experiences, and guide them on potential ways to help you and what matters to you. You may also be asked to undergo some investigations such as scans or a bladder assessment, to help support your referral.

 

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).

Who can get support

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.
  • Non-mesh slings for SUI will also be included if complications have occurred.

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. 

   

What to expect from this service

  • After your referral has been accepted, you will be contacted by one of our female Health Navigators. They will arrange a time to call you and capture your mesh journey. We understand that it can be frustrating and traumatic to constantly be asked to repeat your journey with every new medical person you see. To reduce the potential of this happening, our Health Navigators will listen to your journey and document it. You will be asked for permission for them to record this so they can go back over your conversation and make sure they have captured everything. You will be sent a copy of the interview notes and will get a chance to change anything that is not right. Once you have agreed it is correct, it will be entered into your medical records for the Service so people involved in your treatment will be familiar with it and you won’t have to keep retelling it.

 

  • The Health Navigator’s role is to support you every step of the way as you journey through this service. We have two dedicated Health Navigators:
    • Tiffani Ruffle - Waitematā
    • Pauline Armstrong - Christchurch

 

  • 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. If any travel or accommodation is required, these will be organised by the service for yourself and a support person.

 

  • 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.

 

  • 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).

Location and travel information 

If you have with 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), and

- 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.

Our surgeons

The surgeons in our team have been credentialled for mesh complication work at Tier 3 of the Ministry of Health National Credentialling Framework – Pelvic floor reconstructive, urogynaecological and mesh revision and removal procedures. 

The credentialling process is on-going, and over time as other surgeons become credentialled for Tier 3 procedures they may join the team and offer service to consumers in private practice.

For more information see the National Credentialling Framework: Pelvic floor reconstructive, urogynaecological and mesh revision and removal procedures on the Ministry of Health website.

Pelvic mesh and complications from surgery

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. 

 

The most common procedure involving mesh is known as a mid-urethral sling (MUS) procedure, used to treat stress urinary incontinence. It can also be used to treat rectal prolapse in a procedure called a rectopexy. Pelvic mesh was also used for pelvic organ prolapse (POP) prior to 2017 when this use of mesh was banned in New Zealand.

 

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 (the 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 (the 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. 

Resources

Frequently Asked Questions

If I have an injury from pelvic mesh what support is available to me?

The New Zealand Female Pelvic Mesh Service has been set up for women experiencing complications from certain operations involving the use of surgical mesh.  

A referral is required from a GP or specialist. That is when the Navigators will be in touch to support the consumers’ ongoing care. 

If an injury caused by pelvic mesh is suspected, a claim will be lodged to the Accident Compensation Corporation (ACC).
ACC will investigate the claim and collect information provided by the New Zealand Female Pelvic Mesh Service to help inform its cover decision.

If cover is approved, you will be appointed a recovery team member who will help coordinate your entitlements on a case-by-case basis.  This can include costs associated with:

  • Diagnostics, investigations and assessments
  • Treatment/s (both surgical and non-surgical)
  • Weekly Compensation
  • Transport and accommodation
  • Home and community support
  • Equipment and consumables
  • Rongōa Services

Where is the New Zealand Female Pelvic Mesh Service located?

The service will be based in two locations - one in Ōtautahi (Christchurch) and the other in 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 for people who live outside of these areas.

 

lf you are required to attend an appointment or assessment in person, travel and accommodation expenses may be covered for yourself and a support
person. Your Health Navigator will be able to help with that process.

What is Pelvic Mesh and what are the different names used for it?

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. lt is known by multiple names, including tape, sling' TVT, patch, ribbon, graft or hammock. A mesh implant is a permanent support used to support your urethra and hold your weakened organs in place.

 

These devices are designed to be a permanent implant. The most common procedure involving mesh is known as a mid-urethral sling (MUS) procedure, used to treat stress urinary incontinence. Pelvic mesh is also used to treat Pelvic Organ prolapse. lt is used to treat rectal and bowel prolapse in a procedure called a rectopexy.

What types of pelvic mesh complications does the New Zealand Female Pelvic Mesh Service see?

  • All types of pelvic mesh inserted for pelvic organ prolapse (POP)
  • All types of pelvic mesh inserted for stress urinary incontinence (SUI)
  • Patients with pelvic mesh inserted for POP or SUI, and who also have mesh inserted for rectal prolapse (rectopexy) 
  • Non-mesh slings for SUI will also be included if complications have occurred.

 

The Service is currently not taking referrals for consumers who have had a single procedure for rectal prolapse (rectopexy).  

 

If you have had a rectopexy and mesh was inserted, and you are experiencing problems you will need to see your family doctor and discuss this, you may be referred to the  colorectal services.

Should I be concerned if I have pelvic mesh?

Some women have pelvic mesh implants with no complications and good outcomes. However, this is not true for all women. Some women suffer complications leading to injuries which can be anywhere from minor to serious, severe 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. This is because pelvic mesh hardens over time and as it hardens it can begin to push into and damage surrounding tissues, organs and nerves. It can also move inside your body or become infected or inflamed.

 

lf you have had  pelvic mesh implanted and begin experiencing symptoms, talk to your doctor or specialist.

What are some of the possible pelvic mesh-related complications?

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.

lnfection of damaged tissues, with recurrent urinary tract (bladder)
infections is the most common complication.

lnflammation can result 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.

What symptoms might I notice if I have a pelvic mesh complication?

Symptoms that may be associated with pelvic mesh implant complications include:

  • Pain or spasms at the site of the mesh implant, including vaginal, groin, pelvic area, lower abdominal, lower back, buttock, and/or referred paindown one or both legs.
  • Urinary tract (bladder) infections.
  • VaginaI discharge
  • Difficulty urinating
  • Excessive vaginal or urinary bleeding (note this can be normal)
  • Pain during sexual intercourse and/or painful sex experienced by the partner when they feel the mesh during sexual intercourse
  • Abscess or swelling at the mesh insertion or exit sites
  • lncreased anxiety.

What should I do if think pelvic mesh is affecting my health?

The first step is to talk to your GP or specialist about your symptoms and let them know that you have a pelvic mesh implant. If appropriate they will refer you to the New Zealand Female Pelvic Mesh Service. ln some cases it may be appropriate for them to begin managing your symptoms such as pain or anxiety, while waiting for your referral to be accepted.

 

Once your referral is received it will be assessed. The more information your doctor can provide to support your referral the better. This may mean asking for surgical notes if your operation was not recent. It may also involve your doctor asking some questions which may be personal and uncomfortable for you. These questions are important to help identify if your symptoms are from surgical mesh.

What is the New Zealand Female Pelvic Mesh Service?

The New Zealand Female Pelvic Mesh Service is a new national service that has been established to support and care for women who may be experiencing complications from having pelvic surgical mesh put into their bodies. The New Zealand Female Pelvic Mesh Service is a new national service that has been established to support and care for women who may be experiencing complications from having pelvic surgical mesh put into their bodies.

 

The service consists of a team of health providers from many different specialties such as credentialled surgeons, nurses, physiotherapists, pain physicians, occupational therapists, social workers, and pyschologists. They are committed to caring for women respectfully, transparently and in a supportive environment. This is called a multi-disciplinary team (MDT) approach, with the consumer (you), as a partner in your healthcare team. 

My referral to the pelvic mesh service has been declined, now what? 

Your options will depend on the reason your referral was declined.

 

Sometimes, after the pelvic mesh service staff have gathered all of the required information, it is found that mesh was not inserted or it is not the reason for your symptoms. If they determine that mesh has not been inserted they will let your family doctor know and if appropriate make recommendations to support you further. 

 

Some referrals received by the pelvic mesh service may be for women who have had mesh inserted, but not in the pelvis, for example. Mesh used to repair a hernia. If this is the case, you should see your General Practitioner or Specialist regarding management of this, which may include referral to a surgeon.

Pātiki and Waharua Kōpito patterns

Have more questions?

ACC has a lot of information on claims related to surgical mesh injuries.