Policy briefing

NICE guidance on vaginal mesh surgery

Draft guidance says non-surgical options for urinary incontinence and prolapse must be exhausted first

Draft guidance says non-surgical options for urinary incontinence and prolapse must be exhausted first

Essential facts

Mesh and tape devices inserted through the vaginal wall have been a surgical approach to treat the common conditions of urinary incontinence (UI) and pelvic organ prolapse (POP) in women.

UI, an involuntary release of urine, can affect women of all ages, and have a significant effect on the physical, psychological and social well-being of those affected.


Picture: SPL

Up to 50% of women have POP, when one or more of the organs in the pelvis, including the uterus, bowel and bladder, slip down and bulge into the vagina. One in ten women will need surgery, according to the National Institute for Health and Care Excellence (NICE).

What’s new

Surgery using mesh or tape should only be considered for UI or POP when other non-surgical options have been exhausted or are not possible, according to new guidance.

NICE has published its draft guidance on the use of vaginal mesh following reports it has left a significant minority of women with life-changing injuries and chronic pain.

In July, a severe curb on the use of such surgery was announced by the government because of concerns about its safety. NICE was already considering its guidance after an NHS England Mesh Working Group report published in December 2015 raised concerns about the safety and efficacy of the intervention.

NHS Digital data shows that more than 100,000 women have been given the mesh implants for stress UI in England in the past decade (2008-17).

NICE says women should be offered a full range of non-surgical options before any operation is considered.

It recommends that a national database be set up to record all procedures involving the use of surgical mesh or tape in operations and any complications, to help with future decision-making.

In the cases where it is agreed surgery is to go ahead, women must be informed of the risks, and that the rate of complications is not fully known.

When a woman is believed to be experiencing complications from the surgery, she should be referred to a specialist team, the guidance says. Consultants at centres specialising in the diagnosis and management of such complications should develop an individualised investigation plan for each affected woman.

Implications for nurses

  • Women who have UI should be offered non-surgical options including lifestyle interventions, such as losing weight if their BMI is more than 30, physical therapies including pelvic floor training programmes, behavioural therapies and medication
  • Continence pads should not be considered a UI treatment
  • Non-surgical options for pelvic organ prolapse include lifestyle modification, topical oestrogen, pelvic floor muscle training and pessary management
  • A follow-up appointment should be offered within six months to all women who have had UI or POP surgery
  • Any woman who has experienced a suspected surgical complication should be referred for specialist assessment

 

Expert quote

Ellie Stewart, clinical nurse specialist in urogynaecology at West Suffolk NHS Foundation Trust, says:

‘Both these conditions cause huge quality-of-life issues, and women affected deserve the best care. These conditions affect work, home and sex life. Women are likely to put up with symptoms for years because they are either too embarrassed to ask for help or unaware of the help available.

‘NICE guidance suggests conservative management – including pelvic floor exercises, weight loss, gentle exercise, pessaries and continence management – before any surgery is considered. All women should have tried some or all of the non-surgical options first.

‘Nurses need to be aware of the issues and concerns about the use of mesh surgery. They should advise that patients see their GP for assessment of their symptoms and possible referral back to the place they had their surgery if there are complications.’

 


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