A full range of non-surgical options should be offered to women for stress urinary incontinence or pelvic organ prolapse before any operations, according to new draft guidance from NICE.
The non-surgical options for urinary incontinence include lifestyle interventions, physical therapies, behavioural therapies and medicines. Non-surgical options for pelvic organ prolapse include lifestyle modification, topical oestrogen, pelvic floor muscle training and pessary management.
Where surgery is offered, if a woman’s chosen intervention is not available from the consulting surgeon, she should be referred to an alternative surgeon, the draft guideline recommends.
Surgical interventions using surgical mesh/tape should only be considered when other non-surgical options have failed or are not possible.
A national database should also be set up to record all procedures involving the use of surgical mesh/tape in operations for stress urinary incontinence or pelvic organ prolapse to help with future decision making. In the cases where it is agreed to use surgical mesh/tape, women must be fully informed of the risks.
Sir Andrew Dillon, chief executive of NICE, said: “Our independent advisory committee looked at a range of evidence for interventions for urinary incontinence and pelvic organ prolapse in women and made a series of detailed recommendations, using the best evidence currently available.
“It is important that every woman is supported to make decisions that are right for her, consents to a procedure, and fully understands the benefits and risks of the procedure being offered before consenting to it.
“Where surgical mesh/tape could be an option, there is almost always another intervention recommended in our guideline, which does not involve surgical mesh/tape. If a surgeon cannot provide a full range of choices to the patient, then she should be referred to one who can."
In July a national ‘pause’ was announced by the government on the use by the NHS of surgical mesh/tape to treat stress urinary incontinence and for urogynaecological prolapse where the mesh is inserted through the vaginal wall. This ‘pause’ takes the form of a high vigilance restriction period during which certain conditions apply.
This will remain in place until a number of conditions are met including:
- Registering all operations and any complications on a national database
- Surgery being performed by specialist surgeons based at specialist centres
A follow-up appointment should be offered within six months to all women who have had urinary incontinence or prolapse surgery. The draft guideline also recommends how complications associated with surgical mesh/tape surgery should be assessed and managed.
Consultants at centres specialising in the diagnosis and management of surgical mesh/tape-related complications should develop an individualised investigation plan for each woman with suspected or confirmed mesh-related complications.
There are a number of recommendations included in the guideline for surgical mesh/tape-related complications. These include:
- Referring women who suffer a suspected surgical mesh/tape-related complication to a urogynaecologist, urologist or colorectal surgeon for specialist assessment.
- Referring women with a confirmed surgical mesh/tape-related complication, or unexplained symptoms after a surgical mesh/tape procedure, to a consultant at a regional centre specialising in the diagnosis and management of surgical mesh/tape-related complications.
- The development of an individualised investigation plan for each woman with suspected or confirmed surgical mesh/tape-related complications.