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Mesh surgery should be last resort for incontinence, says NICE

Women with urinary incontinence should only be offered mesh surgery as a last resort, according to new draft guidelines.

The full range of non-surgical options should be offered to women who have urinary incontinence and pelvic organ prolapse before any operations, said the National Institute for Health and Care Excellence (NICE).

For urinary incontinence, lifestyle interventions, physical therapies, behavioural therapies and medicines should be considered before surgery.

For pelvic organ prolapse, lifestyle modification, topical oestrogen, pelvic floor muscle training and pessary management should be offered.

Surgical intervention should only be considered when all the non-surgical options have failed or are not possible, NICE said.


It comes after the government paused the NHS’s use of some vaginal mesh procedures in July and placed heavy restrictions on the surgery.

These restrictions will remain in place until all operations and complications are registered on a national database and the surgery is performed by specialist surgeons based in specialist centres, said NICE.

Thousands of women have complained of complications following the surgery, including constant pain, infections and bowel problems.

Supported to make the best decision

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.

“When 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,”he said.

Access to procedures still “crucial”

The Royal College of Obstetricians and Gynaecologists and The British Society of Urogynaecology welcomed the news and said it was important for women to make informed decisions about the best treatment for their circumstances.

However, it is “crucial” for women who need surgical procedures to be able to access them, they added.

Various stakeholder organisations have been asked to submit comments on these proposed recommendations until the consultation closes on 19 November at 5pm.