Women should be offered non-surgical options for stress urinary incontinence or pelvic organ prolapse before any they undergo any operations, according to guidelines published today.
The proposed guideline, published today (9 October 2018), follows a government announcement in July to pause the NHS use of surgical mesh and tape to treat stress urinary incontinence and for urogynaecological prolapse, where the mesh is inserted through the vaginal wall.
Published by the National Institute for Health and Care Excellence, the guidance sets out steps to be taken to avoid surgical intervention.
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.”
A woman with urinary incontinence should be offered: lifestyle interventions, physical therapies, behavioural therapies and medicines before surgery, while patients with pelvic organ prolapse should be offered: lifestyle modification; topical oestrogen; pelvic floor muscle training; and pessary management.
Surgical interventions using surgical mesh/tape should only be considered when non-surgical options have failed or are not possible, says NICE, while a national database should be set up to record all procedures involving the use of surgical mesh/tape in operations for stress urinary incontinence or pelvic organ prolapse.
NICE also recommends that women have a follow-up appointment within six months of any surgery and any potential complications associated with surgical mesh/tape surgery should be dealt with via an individualised investigation plan for each woman.
Complications related to the device should be reported to the Medicines and Healthcare products Regulatory Agency (MHRA) and details of the complications should be collected in a national registry.
NICE will accept comments on the proposed draft guideline until 19 November 2018.
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