The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on bone-anchored cystourethropexy (using data from In-Tac and Vesica as specified by SERNIP).

As part of NICE's work programme, the current guidance was considered for review but did not meet the review criteria as set out in the IP process guide. The guidance below therefore remains current.


This procedure is used to treat stress urinary incontinence in women.

Stress incontinence is urine leakage that occurs when the pressure within the abdomen is raised, during, for example, lifting, coughing or laughing. It is often due to damage to the pelvic muscles during childbirth, which weakens the normal muscular mechanism of preventing flow of urine into the urethra.

Stress incontinence is a common problem; most women with the condition are treated without surgery. Standard surgical treatments in women with severe stress incontinence include hysterectomy, vaginal repair, or laparoscopic or open surgery to lift the uterus (colposuspension). Minimally invasive procedures that can be carried out under local anaesthetic or sedation have been developed recently. These include needle suspension procedures.  During 2000/2001, about 10,000 operations on the outlet of the female bladder were carried out in England (Source: Hospital Episode Statistics, ungrossed for missing data, Department of Health). About 4000 were open abdominal operations, and about 3000 were transvaginal.

Bone-anchored cystourethropexy is a minimally invasive bladder neck needle suspension procedure. Bone anchors are screwed into the pubic bone and sutures are then passed either side of the bladder neck. These sutures are then elevated and tied to the bone anchors to suspend the bladder neck.

Coding recommendations


SNOMED CT preferred term (concept ID)

Bone-anchored cystourethropexy (821991000000109)

One of the following OPCS-4 codes may be assigned depending on the operative method used:

M51.8 Other specified combined abdominal and vaginal operations to support outlet of female bladder

M51.9 Unspecified combined abdominal and vaginal operations to support outlet of female bladder

Diagnosis or health condition

SNOMED CT preferred term (concept ID)

Female stress incontinence (60241006)