This has been developed by Te Whatu Ora's New Zealand Female Pelvic Mesh Service (NZFPMS) at the request of the Mesh Roundtable and work has involved representatives from both RACS and RANZCOG. We are sharing this information with members on behalf of Manatū Hauora Ministry of Health.
Exceptions process
To be considered for an exception to the pause in the use of mesh for SUI, cases need to be considered by a specifically constituted multidisciplinary meeting (MDM) that is led by the NZFPMS. The MDM will consider cases carefully and is the substantive part of the decision-making process.
MDM attendance:
- Chair Dr Hazel Ecclestone (Urologist, Taranaki District Hospital)
- 1 NZFPMS Tier 3 credentialled surgeon
- 1 Tier 2 credentialled surgeon Gynaecologist
- Presenting (requesting) surgeon
- CNS Incontinence
- Pelvic Health Physiotherapist
- MDM Coordinator
- Radiologist, Stoma Nurse invited as required
After the MDM there will be a process check by the office off the Chief Clinical Officers at Manatū Hauora Ministry of Health. This step will not re-examine clinical aspects of the case but will ensure that appropriate process has been followed.
There will not be an 'appeal' process as the MDM has the comprehensive knowledge and skills required to make decisions. There will be opportunities to present new or updated clinical information on a given patient via the MDM process.
Criteria for mesh exceptions
All surgeons undertaking female SUI procedures in New Zealand can refer and present a case to the Mesh Exception MDM. Criteria are:
- Patients for whom there is evidence of harm (defined in a patient centric manner) from delaying surgical treatment until the pause is lifted, or surgeon and referring MDM advice is that a non-mesh procedure may carry additional risks
- Patients who have been discussed according to the interim high vigilance guideline for non-mesh SUI surgery and it was agreed that requesting an exception for mesh is appropriate
- At this time, patient choice for use of mesh over other treatment options, where the responsible surgeon and MDM consider the other treatment options suitable, is not an accepted reasons for seeking an exception.
