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RCOG and BSUG response to NICE guidance on transvaginal mesh repair for prolapse

News 15 December 2017

This NICE IPG refers only to the use of mesh to reinforce pelvic organ prolapse repair for anterior and posterior wall prolapse. It does not refer to the use of mesh or tape for stress urinary incontinence or vaginal vault surgery which are subject to different NICE IPG’s. The NICE Clinical Guideline on Urinary Incontinence and Pelvic Organ Prolapse is due to be published in 2019.

Mr Edward Morris, vice president for clinical quality at the Royal College of Obstetricians and Gynaecologists, said:

“This guidance from NICE recommends that vaginal placement of mesh to repair prolapse should only be used in the context of research. Current evidence does not recommend the routine use of mesh to treat prolapse as the first surgical intervention, due to higher complication rates when compared to non-mesh repairs. Therefore this guidance is consistent with the majority of UK current clinical practice.

“However, there is a small subset of women for whom other surgical interventions are not appropriate for their prolapse and the use of mesh may be of benefit to them, provided they have appropriate information and counselling about the risks and benefits, and have explored all other treatment options. We are concerned that this guidance may leave these women without an effective option to manage their condition.

“This step also means that there is a risk further research in this area could cease – we therefore urge NICE to recommend this as a priority area in order to ensure we have the optimal surgical approach to care for women with prolapse.

“It is paramount that women with pelvic organ prolapse are made aware of all the treatment options available, and empowered with information about the risks associated with any procedures, to enable them to make an informed decision about the right treatment for their condition.  Specialist training, surgical experience and appropriate patient selection are all crucial factors in ensuring current and future patients receive the highest quality care.” 

Professor Jonathan Duckett, Chair of the British Society for Urogynaecology (BSUG), said:

“The recent NHS England report outlined the ongoing work taking place across the NHS to ensure good outcomes for all women undergoing procedures involving mesh and reduce the number of those experiencing complications.

“BSUG are aware there is currently an incomplete picture of the long-term recording of outcomes and the incidence of complications following all pelvic surgery, not just mesh surgery, due to insufficient reporting and published data. We strongly recommend that all data relating to mesh procedures are recorded on the BSUG database and that any complications are similarly recorded and reported to the MHRA via the Yellow Card scheme. It is only by the routine use of such systems that we will can track trends and better inform both patients and surgeons.

"We are also urging reporting authorities to make a clear distinction between the vaginal mesh for prolapse which is the subject of this NICE IPG and the incontinence mesh devices or the abdominal mesh for prolapse to which this document does not relate."