Surgical options for urinary incontinence or pelvic organ prolapse should only be considered if all other options are not possible, according to a new draft guideline published today (Tuesday 9 October) by the National Institute for Health and Care Excellence (NICE).

The new guideline means that surgeons will have to consider a number of non-surgical options before invasive surgery is discussed. For those with urinary incontinence, this includes:

  • Lifestyle interventions
  • Physical therapies
  • Behavioural therapies
  • Medicines

 

Similarly, for people suffering with pelvic organ prolapse, non-invasive options include:

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

 

"This is a step in the right direction however our concerns remain that private hospitals will ignore these guidelines in the same way they have failed to implement the pause on mesh surgery that the government has imposed on the NHS."

Linda Millband of Thompsons Solicitors

It adds that, if a surgeon is unable to perform one of the non-invasive options above, they should be referred to a surgeon who can. If surgery is the only option, patients must be aware of risks beforehand.

NICE also recommends that a national database should be set up to record all procedures involving the use of surgical mesh/tape, and any complications, in operations for stress urinary incontinence or pelvic organ prolapse.

Thompsons Solicitors is currently representing more than 200 people who have been left in serious pain and with life-changing complications as a result of vaginal or rectal mesh implants. It also supports Sling the Mesh, a campaign aiming to raise awareness of the risks of mesh surgery and advocate a full audit into its effects.

While Thompsons Solicitors welcomes NICE’s new guidelines, the firm argues that more needs to be done and that the UK government must ban the use of mesh outright, in all types of operation.

Linda Millband, national head of medical negligence at Thompsons Solicitors, said: “NICE has finally issued guidelines that say mesh surgery for stress urinary incontinence or pelvic organ prolapse should be a last resort. This is a step in the right direction however our concerns remain that private hospitals will ignore these guidelines in the same way they have failed to implement the pause on mesh surgery that the government has imposed on the NHS.

“The real answer here is for the government and NICE to stop making small amends to guidance and to issue an absolute ban on mesh use until its risks are fully investigated, and patients can be confident about its safety.

“NICE has recommended a limited register for mesh-related operations, whereas we support the call by Sling the Mesh for a complete register of not only those who are due to have mesh surgery but all those operated on in the past. Only then will the true scale of this medical scandal be revealed.”