The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on insertion of biological slings for stress urinary incontinence.
Stress urinary incontinence is the involuntary leakage of urine during exercise or certain movements such as coughing, sneezing and laughing. It is usually due to weak or damaged muscles in the pelvic floor or sphincter.
Conservative treatments include pelvic floor muscle training, electrical stimulation, biofeedback, and mechanical devices (urethral plugs and inserts). Surgery is usually used if conservative treatments fail. There are four main types of surgical intervention: colposuspension, insertion of a tension-free vaginal tape, traditional suburethral slings and injectable agents.
Sling procedures are performed partly through the vagina and partly through a small abdominal incision, usually under general anaesthesia. The sling may be made of a strip of tissue from the patient's own abdominal fascia, from human donor tissue or from animal tissue. A tunnel is created under the mid or proximal urethra, extending upwards through the endopelvic fascia on both sides towards the back of the rectus sheath. The sling of allograft or xenograft material is suspended from the rectus sheath or anterior abdominal wall by loose sutures, creating a supporting 'hammock' for the urethra. Bone screws may sometimes be used to hold the sutures in place and anchor the sling to the pubis.
Depending on the exact procedure performed one of the following OPCS-4 codes is selected:
M51.1 Abdominoperineal suspension of urethra
Includes: Abdominovaginal suspension of urethra
M52.1 Suprapubic sling operation
M52.2 Retropubic suspension of neck of bladder
M52.3 Colposuspension of neck of bladder
Note: OPCS-4 code Y27.1 Autograft to organ NOC, Y27.2 Allograft to organ NOC or Y27.3 Xenograft to organ NOC is assigned in addition to one of the above codes if the information is available.