Guidance advises that mesh surgery should be a last resort

9th October 2018

Guidance released by the National Institute for Health and Care Excellence (NICE) says that women who need treatment for urinary incontinence should only be offered mesh surgery as a last resort.

The guidance is still in draft form and is expected to be finalised by April 2019. It advises that non-surgical options, should as pelvic muscle exercises, should be the first option.

Christian Beadell, senior solicitor in the medical negligence team at Fletchers, said: “The draft guidelines from NICE provide a solid basis for discussion and whilst not yet in force, will undoubtedly inform much clinical practice going forward.

“The headline conclusions from the review are:

– Women MUST be made fully aware of all risks and alternatives treatments. There must be a detailed discussion of the options, including no treatment.

– Conservative management should be considered before surgery

– Mesh in the treatment of pelvic organ prolapse and stress urinary incontinence has a place

– Details of the implanting surgeon and the device use must be clearly recorded.

“The most important additions to the current guidelines are detailed recommendations for investigating and managing mesh related complications. This was an issue that was flagged as being crucial earlier this year as part of the Independent Medicines and Medical Devices Safety Review. The NHS then announced a pause on the use of mesh with Baroness Cumberlege (who chaired the review) stressing that meshes could not be used to treat stress urinary incontinence until we could “manage the risk of complications much more effectively.”

“Whilst some groups and experts have already expressed their concerns that an outright ban has not been issued, the extensive evidence base for guideline does show that a measured approach is being taken. The return to informed patient choice is important in delivering responsible healthcare and ensuring that for those patients for who other treatments have failed, a mesh repair remains an option.

“Whilst the pause on the use of mesh remains in force, it may only be a matter of time before this is removed.”

It is estimated that more than 100,000 women in the UK have had a mesh fitted. The net-like fabric can be attached into the wall of the vagina to act as a scaffold to support organs, such as the bladder, to keep them in the right place to help manage incontinence or another condition called prolapse.

The new guidelines make it clear that any woman considering having the surgery for incontinence or prolapse should be fully aware of the possible risks which include infection, bleeding and bowel problems.

The guidelines published by NICE can be viewed here: https://www.nice.org.uk/guidance/

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