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Surgical mesh last resort for prolapse or incontinence

Only consider mesh or tape when all other non-surgical options have failed or are not possible

Louise Prime

Tuesday, 09 October 2018

Surgical mesh or tape should be considered only as a last resort for women with stress urinary incontinence or pelvic organ prolapse when all other non-surgical options have failed or are not possible, the National Institute for Health and Care Excellence (NICE) advised this morning. NICE insisted that wherever surgical mesh/tape could be an option, there is almost always another recommended intervention that does not involve its use – and if a surgeon cannot provide a full range of choices to the patient, then they should refer her to another who can.

In its draft guidance published for consultation this morning, NICE insisted that women should be offered a full range of non-surgical options for stress urinary incontinence or pelvic organ prolapse before any operations. It said there are several non-surgical options for both urinary incontinence and pelvic organ prolapse, that should be considered before surgery. Its recommended non-surgical options for urinary incontinence include:

  • lifestyle interventions
  • physical therapies
  • behavioural therapies
  • medicines.
Recommended non-surgical options for pelvic organ prolapse include:
  • lifestyle modification
  • topical oestrogen
  • pelvic floor muscle training
  • pessary management.
NICE said that in the cases where it is agreed to use surgical mesh/tape, women must be fully informed of the risks. For surgery for incontinence this information should cover differences in type of anaesthesia, expected length of hospital stay, surgical incisions and expected recovery period; and where mesh is to be used in prolapse surgery, it should cover what type of mesh will be used and whether it is permanent, as well as the uncertainty about long-term complications associated with mesh and about the proportion of women affected.

It also called for a national database to 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.

NICE chief executive Sir Andrew Dillon commented: “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.

“Surgeons must also record any intervention using surgical mesh/tape in a national database.

“The guideline committee was asked to look at a range of interventions and examine the evidence for them. Importantly, our recommendations offer women a range of options for treatment that don’t involve the use of surgical mesh/tape.”

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