NICE: offer non-surgical options for urinary incontinence first

NICE: non-surgical options for urinary incontinence to be offered first

Women should be offered a full range of non-surgical options for urinary incontinence or pelvic organ prolapse before any operations, NICE has said in a new draft guideline.

There are a number of non-surgical options for urinary incontinence and pelvic organ prolapse, which should be considered before surgery.

The non-surgical options for urinary incontinence include:

  • Lifestyle interventions
  • Physical therapies
  • Behavioural therapies
  • Medicines

Non-surgical options for pelvic organ prolapse include:

  • Lifestyle modification
  • Topical oestrogen
  • Pelvic floor muscle training
  • Pessary management

Where surgery is offered, if a woman’s chosen intervention is not available from the consulting surgeon, she should be referred to an alternative surgeon, the draft guideline recommends.

Surgical interventions using surgical mesh/tape should only be considered when non-surgical options for urinary incontinence have failed or are not possible.

A national database should 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.

In the cases where it is agreed to use surgical mesh/tape, women must be fully informed of the risks, the independent NICE committee said in the draft guideline.

In July a national ‘pause’ was announced by the government on the use by the NHS of surgical mesh/tape to treat stress urinary incontinence and for urogynaecological prolapse where the mesh is inserted through the vaginal wall. This ‘pause’ takes the form of a high vigilance restriction period during which certain conditions apply.

This will remain in place until a number of conditions are met including:

  • Registering all operations and any complications on a national database
  • Surgery being performed by specialist surgeons based at specialist centres

“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.”

The draft guideline also recommends how complications associated with surgical mesh/tape surgery should be assessed and managed.

There are a number of recommendations included in the guideline for surgical mesh/tape-related complications. These include:

  • Referring women who suffer a suspected surgical mesh/tape-related complication to a urogynaecologist, urologist or colorectal surgeon for specialist assessment.
  • Referring women with a confirmed surgical mesh/tape-related complication, or unexplained symptoms after a surgical mesh/tape procedure, to a consultant at a regional centre specialising in the diagnosis and management of surgical mesh/tape-related complications.
  • The development of an individualised investigation plan for each woman with suspected or confirmed surgical mesh/tape-related complications.

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.

“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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